ORIGINAL ARTICLES

Invasive pulmonary cryptococcal infection masquerading as lung cancer with brain metastases: A case report

Chidiebere Peter Echieh¹, Chimaobi Nwagboso¹, Stephen Ogbudu¹, John Eze1, Ernest Ochang², Paul Jibrin³, Anietimfon Etiuma¹, Okon Bassey¹

¹ Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
² Department of Microbiology, University of Calabar, Calabar, Cross River State, Nigeria
³ Department of Pathology, National Hospital, Abuja, Nigeria

Correspondence Address:
Dr. Chidiebere Peter Echieh
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar. Nigeria

Source of grant: None
Conflict of Interest: None

Background: Cryptococcosis, a global disease problem, seen frequently in the immuno-suppressed, also affects patients without apparent immuno-suppression. Pulmonary cryptococcosis patients often present as cryptococcal pneumonia, whereas intracranial cryptococcosis presents with meningitis. We present a 33-year-old immunocompetent man, diagnosed with invasive pulmonary cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary thoracic, extra-thoracic as well as computed tomography (CT) scan features suggestive of lung cancer. Cryptococcosis was diagnosed by identification of oval thick-walled yeast on histology of lung biopsy specimen. The patient was treated with flucytosine and fluconazole initially and subsequently with Amphotericin B and fluconazole. He made clinical improvement with the resolution of symptoms but had residual radiological features. Invasive cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.