Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature
Abstract Background Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-4343-2 |
| _version_ | 1811327057719721984 |
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| author | Yuan Zhang Sean X. Zhang Julie Trivedi Adam D. Toll Julie Brahmer Russell Hales Sarah Bonerigo Mingying Zeng Huiping Li Rex C. Yung |
| author_facet | Yuan Zhang Sean X. Zhang Julie Trivedi Adam D. Toll Julie Brahmer Russell Hales Sarah Bonerigo Mingying Zeng Huiping Li Rex C. Yung |
| author_sort | Yuan Zhang |
| collection | DOAJ |
| description | Abstract Background Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed. |
| first_indexed | 2024-04-13T14:59:54Z |
| format | Article |
| id | doaj.art-4325620e58a44b37a426e39b841ed0c9 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-13T14:59:54Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-4325620e58a44b37a426e39b841ed0c92022-12-22T02:42:19ZengBMCBMC Infectious Diseases1471-23342019-08-011911710.1186/s12879-019-4343-2Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literatureYuan Zhang0Sean X. Zhang1Julie Trivedi2Adam D. Toll3Julie Brahmer4Russell Hales5Sarah Bonerigo6Mingying Zeng7Huiping Li8Rex C. Yung9Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineDepartment of Pathology, Johns Hopkins University School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins University School of MedicineDepartment of Pathology, Johns Hopkins University School of MedicineDepartment of Medical Oncology, Johns Hopkins University School of MedicineDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of MedicineDepartment of Medical Oncology, Johns Hopkins University School of MedicineDepartment of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineDepartment of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of MedicineDepartment of Pulmonary and Critical Care Medicine, Johns Hopkins University School of MedicineAbstract Background Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.http://link.springer.com/article/10.1186/s12879-019-4343-2Pulmonary cryptococcosisPleural effusionCrytococcal antigenLateral flow assay |
| spellingShingle | Yuan Zhang Sean X. Zhang Julie Trivedi Adam D. Toll Julie Brahmer Russell Hales Sarah Bonerigo Mingying Zeng Huiping Li Rex C. Yung Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature BMC Infectious Diseases Pulmonary cryptococcosis Pleural effusion Crytococcal antigen Lateral flow assay |
| title | Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature |
| title_full | Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature |
| title_fullStr | Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature |
| title_full_unstemmed | Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature |
| title_short | Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature |
| title_sort | pleural fluid secondary to pulmonary cryptococcal infection a case report and review of the literature |
| topic | Pulmonary cryptococcosis Pleural effusion Crytococcal antigen Lateral flow assay |
| url | http://link.springer.com/article/10.1186/s12879-019-4343-2 |
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