Wang WY, Zheng YL, Jiang LB. Cryptococcal antigen testing of lung tissue homogenate improves pulmonary cryptococcosis diagnosis: Two case reports. World J Clin Cases 2022; 10(12): 3893-3898 [PMID: 35647158 DOI: 10.12998/wjcc.v10.i12.3893]
Corresponding Author of This Article
Li-Bin Jiang, Doctor, MD, Chief Doctor, Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. jkzjuedu@163.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 26, 2022; 10(12): 3893-3898 Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3893
Cryptococcal antigen testing of lung tissue homogenate improves pulmonary cryptococcosis diagnosis: Two case reports
Wei-Yi Wang, Yu-Lu Zheng, Li-Bin Jiang
Wei-Yi Wang, Li-Bin Jiang, Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Yu-Lu Zheng, Department of Respiratory Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Jiang LB performed the postoperative evaluation and diagnosis; Wang WY and Zheng YL reviewed the literature and contributed to manuscript drafting; Wang WY collected the medical data; all authors issued final approval for the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Bin Jiang, Doctor, MD, Chief Doctor, Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. jkzjuedu@163.com
Received: September 1, 2021 Peer-review started: September 1, 2021 First decision: November 22, 2021 Revised: November 30, 2021 Accepted: March 7, 2022 Article in press: March 7, 2022 Published online: April 26, 2022 Processing time: 232 Days and 1.1 Hours
Abstract
BACKGROUND
Pulmonary cryptococcosis (PC) is an opportunistic infectious disease of the respiratory system. Lung tissue biopsies, culture of respiratory samples (e.g., sputum, lung tissue, pleural fluid, and bronchoalveolar lavage fluid), and cryptococcal antigen (CrAg) testing are helpful for a definitive diagnosis. However, these tests are sometimes falsely negative. PC is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms, poor imaging specificity, and false-negative laboratory tests.
CASE SUMMARY
We report two female patients who underwent computed tomography-guided percutaneous needle pulmonary biopsy of a lung nodule for a confirmed diagnosis. In both patients, the CrAg test on the lung biopsy tissue homogenate was positive, while the serum CrAg test was negative. Combined with the lung tissue pathology, we made the diagnosis of PC. Antifungal therapy was effective in both patients.
CONCLUSION
Given the findings of our cases and the literature review, lung tissue homogenate CrAg testing can be helpful in improving the diagnosis of PC.
Core Tip: Pulmonary cryptococcosis (PC) is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms, poor imaging specificity, and false-negative laboratory tests. We presented two cases of PC wherein serum cryptococcal antigen (CrAg) tests were negative; however, CrAg tests using lung tissue homogenate were positive. Our report aims to highlight the dilemma in diagnosing PC, as well as a novel adjunct in the diagnostic work-up for PC–cryptococcal antigen tests on lung tissue homogenates.
