Gao CY, Yang XJ, Guo E, Zheng YL. Invasive pulmonary cryptococcosis mimicking metastatic lung cancer: A case report and review of literature. World J Clin Cases 2025; 13(20): 105133 [DOI: 10.12998/wjcc.v13.i20.105133]
Corresponding Author of This Article
Yu-Lan Zheng, Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jinzhou Street, Xiangyang 441000, Hubei Province, China. 2591797969@qq.com
Research Domain of This Article
Medicine, General & Internal
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. Jul 16, 2025; 13(20): 105133 Published online Jul 16, 2025. doi: 10.12998/wjcc.v13.i20.105133
Invasive pulmonary cryptococcosis mimicking metastatic lung cancer: A case report and review of literature
Cheng-Yan Gao, Xue-Jiao Yang, E Guo, Yu-Lan Zheng
Cheng-Yan Gao, School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China
Xue-Jiao Yang, Yu-Lan Zheng, Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei Province, China
E Guo, Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Xiangyang 441000, Hubei Province, China
Author contributions: Gao CY contributed to manuscript writing and editing, and data collection; Yang XJ and Guo E helped with case material and graphical analysis support; Zheng YL contributed to conceptualization and case supervision; and all authors have read and approved the final manuscript.
Informed consent statement: The standardized BMC consent form was used with the patient providing informed consent for use of clinical images and for relay of personal clinically related information pertaining to their case for publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Yu-Lan Zheng, Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jinzhou Street, Xiangyang 441000, Hubei Province, China. 2591797969@qq.com
Received: January 12, 2025 Revised: February 21, 2025 Accepted: March 17, 2025 Published online: July 16, 2025 Processing time: 86 Days and 23.8 Hours
Abstract
BACKGROUND
Worldwide, there has been a steady increase in the number of cases of pulmonary cryptococcosis diagnosed in immunocompetent patients, where symptoms can range from mild to severe. Clinical and radiological distinction of disease may be made when compared with immunodeficient cases and in those presenting with primary lung carcinoma. In the latter case confusion can lead to initial misdiagnosis and delayed treatment. We report a case of disseminated cryptococcosis in an immunocompetent patient which mimicked a primary lung carcinoma with brain metastases.
CASE SUMMARY
A 51-year-old male farmer with a 30-year smoking history presented with a two-week history of productive cough, streaky hemoptysis, and low-grade fever. He had no history of immunosuppression, tuberculosis, or specific risk factors. Chest computed tomography revealed a posterior basal left lower lobe mass, but tumor markers and transbronchial tests were negative. Brain magnetic resonance imaging showed an enhancing left frontal lobe lesion, raising suspicion for metastatic lung cancer. However, computed tomography-guided biopsy confirmed fungal pneumonia with “titan” cells, and a positive serum cryptococcal antigen test confirmed Cryptococcus neoformans infection. Bronchoscopy and lavage detected fungal spores, while cerebrospinal fluid cytology and culture were negative. Fluconazole (0.4 mg/day) was initiated, but progressive central nervous system lesions required amphotericin B. A six-week combination of fluconazole (600 mg/day) and flucytosine led to resolution. At 24-month follow-up, he remained asymptomatic with no recurrence.
CONCLUSION
Cryptococcosis is increasing in immunocompetent individuals in China and should be considered in pneumonia and lung or brain lesions.
Core Tip: Cryptococcosis can closely mimic metastatic lung cancer, particularly in immunocompetent individuals, leading to potential misdiagnosis and delayed treatment. This case highlights the critical role of a multidisciplinary diagnostic approach, including imaging, laboratory testing, and histopathological examination, in distinguishing pulmonary cryptococcosis from malignancy. Despite negative cerebrospinal fluid findings, brain lesions were present, emphasizing the need for comprehensive immune evaluation. Early recognition and appropriate antifungal therapy can lead to favorable outcomes, underscoring the importance of considering cryptococcosis in the differential diagnosis of lung and brain lesions.
