January 1-December 1, 2016
Background --- Pulmonary cryptococcosis is a disease occurring worldwide. The patient's immune status is the main factor determining the pathogenicity and histopathologic features of lung infection. Majority of normal hosts with cryptococcal infections are usually asymptomatic and only a small proportion has pulmonary symptoms. This report is prepared to present a pulmonary infection, its clinical presentation, histopathologic findings and course of the disease as a relatively rare case in this institution.
Case --- This patient is a 62 year-old male, known case of diabetes mellitus and chronic kidney disease who experienced non-productive cough, fever and difficulty of breathing. Few hours prior to admission, patient had episode of fever and difficulty of breathing which warranted admission. CT scan of the chest revealed a pulmonary artery aneurysm in the medial basal right lower lung measuring 1.6x1.1 cm with an impression considering mycotic aneurysm in the peripheral right pulmonary artery in the medial basal right lower lung. Subsequent CT Scan guided biopsy of the lesion was done. The patient was treated as a case of cryptoccocosis in an immunocompromised state and cytologic examinations revealed positive for Cryptococcus neoformans.
Findings --- On gross examination, the specimen consists of 2 ml of mucoid to bloody right lung aspirate and the smears prepared show numerous yeast cells with thick mucoid capsular halos frequently in monolayers and "honeycomb" pattern, admixed with several macrophages, some lymphocytes and neutrophils, some in vague granuloma formation, in a background of several red blood cells. The cell block shows scattered fungal yeast cells closely associated with macrophages and lymphocytes. No definite malignant cells identified. Special stain (PAS) done in the cell block show bright red color of the yeasts and pale red color of the capsule with spiney formation. The final diagnosis was chronic inflammation with granuloma formation; numerous fungal microorganisms morphologically consistent with Cryptococcus neoformans.
Conclusion --- Pulmonary cryptococcosis is a relatively rare disease in the Philippines due to limited number of reported cases. This disease is commonly seen among immunocompromised individuals including patients with AIDS. Proper approach in early detection and diagnosis should be followed to ensure good patient outcomes. This case implies that incidence of a lung lesion in an immunocompromised should never be underestimated regardless of HIV status. The authors hereby present a rare case of pulmonary infection in this institution.