Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature

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flucytosine 1 infectiousdiseasesdrugs
meningitis 1 infectiousdiseases
moxifloxacin 1 infectiousdiseasesdrugs
pneumonia 3 infectiousdiseases
pulmonary cryptococcosis 32 infectiousdiseases
pulmonary tuberculosis 1 infectiousdiseases
tuberculosis 4 infectiousdiseases
cryptococcosis 42 infectiousdiseases
fluconazole 5 infectiousdiseasesdrugs
ceftizoxime 1 infectiousdiseasesdrugs

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ceftizoxime 5324 results, we considered that she might have pulmonary bacterial infection and prescribed moxifloxacin and ceftizoxime as empirical treatment. After 2 weeks of antibiotic therapy, another CT examination was performed to
fluconazole 1171 computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis
fluconazole 6223 red-colored yeast walls, suggesting pulmonary cryptococcosis (Fig. 2). The patient was then treated with fluconazole 0.2 g twice daily, and her condition was monitored with regular CT examinations.Fig. 2a Histopathological
fluconazole 6575 stains the yeast wall a red color, suggesting pulmonary cryptococcosisDuring 6-month treatment with fluconazole , the patient underwent CT examination a total of four times, showing great improvement in her lesion
fluconazole 15706 in a missed diagnosis.Regarding the treatment of cryptococcosis, clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole
fluconazole 15810 fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe symptoms or disseminated cryptococcosis [[23]]. A recent study proposed that surgical resection
flucytosine 15786 guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe symptoms or disseminated cryptococcosis [[23]]. A recent study proposed
moxifloxacin 5307 patient’s CT results, we considered that she might have pulmonary bacterial infection and prescribed moxifloxacin and ceftizoxime as empirical treatment. After 2 weeks of antibiotic therapy, another CT examination
Select Disease Character Offset Disease Term Instance
cryptococcosis 48 Title: Journal of Medical Case ReportsPulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literatureLiyang LiLiang ZhuangJian
cryptococcosis 316 11/2018Publication date (pmc-release): 11/2018Publication date (collection): /2018AbstractBackgroundPulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific
cryptococcosis 649 bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis
cryptococcosis 749 cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented.Case presentationA 52-year-old immunocompetent Han Chinese woman
cryptococcosis 1014 complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to
cryptococcosis 1275 fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis,
cryptococcosis 1531 poorer prognosis.ConclusionsOur patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.BackgroundPulmonary cryptococcosis is a fungal infection due to the inhalation
cryptococcosis 1597 reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.BackgroundPulmonary cryptococcosis is a fungal infection due to the inhalation of Cryptococcus neoformans or Cryptococcus gattii spores
cryptococcosis 2061 system through the bloodstream, depending on patients’ immune status [[3]]. The diagnosis of pulmonary cryptococcosis is challenging, given its nonspecific clinical and radiographic features. The differential diagnosis
cryptococcosis 2326 bacterial pneumonia is sometimes hard. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor [[3]–[5]]. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis
cryptococcosis 2438 cryptococcosis as a malignant tumor [[3]–[5]]. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor was only presented in a few reports [[6]–[10]].In this report, we describe a case
cryptococcosis 2624 this report, we describe a case of an immunocompetent woman who was first diagnosed with pulmonary cryptococcosis by percutaneous lung biopsy. But after 6-month antifungal therapy, a part of her lesions was not resolved,
cryptococcosis 5641 resolved, and patchy consolidation was reported, suggesting that another diagnosis, such as pulmonary cryptococcosis , secondary pulmonary tuberculosis, or malignant tumor, should be taken into consideration. After that,
cryptococcosis 6163 inflammation, and periodic acid-Schiff (PAS) staining showed red-colored yeast walls, suggesting pulmonary cryptococcosis (Fig. 2). The patient was then treated with fluconazole 0.2 g twice daily, and her condition was monitored
cryptococcosis 6531 granulomatous inflammation. b Periodic acid-Schiff stains the yeast wall a red color, suggesting pulmonary cryptococcosis During 6-month treatment with fluconazole, the patient underwent CT examination a total of four times,
cryptococcosis 9458 Gefitinib has been continued.Discussion and conclusionsOur patient was finally diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. She was immunocompetent without any history of contact with poultry
cryptococcosis 9776 pathological report was granulomatous inflammation, and PAS staining was positive, suggesting pulmonary cryptococcosis . Fluconazole was used for 6 months, and the lesions partly resolved. The second biopsy of another lesion
cryptococcosis 9938 lesions partly resolved. The second biopsy of another lesion was performed 10 months after pulmonary cryptococcosis was diagnosed, revealing adenocarcinoma. Postoperative pathology showed metastasis in lymph nodes, suggesting
cryptococcosis 10860 malignancies, diabetes mellitus, hepatic cirrhosis, among others [[12], [13]]. In China, pulmonary cryptococcosis ranked as the third most common pulmonary fungal infection, and most Chinese patients with pulmonary
cryptococcosis 10976 ranked as the third most common pulmonary fungal infection, and most Chinese patients with pulmonary cryptococcosis do not have underlying diseases [[14]]. Our patient was an immunocompetent patient without an immunity-associated
cryptococcosis 11147 an immunocompetent patient without an immunity-associated medical history.The pathogen of pulmonary cryptococcosis is the following two subspecies of the Cryptococcus family: C. neoformans and C. gattii. They are abundant
cryptococcosis 11444 affects immunocompromised patients worldwide, whereas C. gattii is usually related to immunocompetent cryptococcosis in tropical and subtropical areas [[12], [15]]. The patient denied any history of contact with birds
cryptococcosis 11724 idea about when and where she was incidentally infected by spores.The common symptoms of pulmonary cryptococcosis are cough, fever, pleuritic pain, dyspnea, hemoptysis, fatigue, and weight loss [[16]], all of which
cryptococcosis 11943 symptoms overlapping the clinical features of lung cancer. Immunocompetent patients with pulmonary cryptococcosis usually have cough as their only symptom, and one-fourth remain asymptomatic [[11]], which makes it
cryptococcosis 12336 diagnoses should be considered according to her clinical symptoms.The radiographic features of pulmonary cryptococcosis are also atypical. The common CT manifestations of pulmonary cryptococcosis were solitary or multiple
cryptococcosis 12412 radiographic features of pulmonary cryptococcosis are also atypical. The common CT manifestations of pulmonary cryptococcosis were solitary or multiple pulmonary nodules or masses [[17]], making it difficult to distinguish cryptococcosis
cryptococcosis 12524 cryptococcosis were solitary or multiple pulmonary nodules or masses [[17]], making it difficult to distinguish cryptococcosis from malignant tumor and bacterial pneumonia. It has been reported that among cases of pulmonary cryptococcosis
cryptococcosis 12636 cryptococcosis from malignant tumor and bacterial pneumonia. It has been reported that among cases of pulmonary cryptococcosis coexisting with lung cancer, adenocarcinoma is the main histological type, probably because cryptococcosis
cryptococcosis 12743 cryptococcosis coexisting with lung cancer, adenocarcinoma is the main histological type, probably because cryptococcosis is apt to occur in the periphery of the lung, where adenocarcinoma is commonly found [[18]]. Cavitation
cryptococcosis 13055 effusion and lymphadenectasis sometimes occur as well [[20]]. Many case reports describe that pulmonary cryptococcosis mimicked lung cancer [[3]–[5], [21]]. In our patient’s case, however, pulmonary cryptococcosis was
cryptococcosis 13154 cryptococcosis mimicked lung cancer [[3]–[5], [21]]. In our patient’s case, however, pulmonary cryptococcosis was coexistent with adenocarcinoma, which is rarely reported. On the basis of her CT examination, we
cryptococcosis 13669 diagnosed as adenocarcinoma (Fig. 1a). We supposed that adenocarcinoma occurred earlier than pulmonary cryptococcosis . It was reported that malignant tumor might lead to immunodeficiency and result in cryptococcosis [[9]].Laboratory
cryptococcosis 13767 pulmonary cryptococcosis. It was reported that malignant tumor might lead to immunodeficiency and result in cryptococcosis [[9]].Laboratory tests are helpful for diagnosing respiratory diseases. But in pulmonary cryptococcosis,
cryptococcosis 13871 cryptococcosis [[9]].Laboratory tests are helpful for diagnosing respiratory diseases. But in pulmonary cryptococcosis , laboratory tests such as white blood count, CRP, and renal and liver function, are usually normal.
cryptococcosis 14093 believe that tumor markers may be the main points of interest in laboratory tests to identify pulmonary cryptococcosis and malignant tumor. Serum cryptococcal antigen titer is often used to diagnose cryptococcosis [[1]].
cryptococcosis 14188 pulmonary cryptococcosis and malignant tumor. Serum cryptococcal antigen titer is often used to diagnose cryptococcosis [[1]]. Because there was no serum cryptococcal antigen titer available in our hospital, we did not detect
cryptococcosis 15403 granulomatous inflammation with positive PAS staining, consistent with the classic manifestation of pulmonary cryptococcosis [[2]]. Taking pathological results as a gold standard, owing to the regression of one of the lesions
cryptococcosis 15655 excluded the diagnosis of malignant tumor, which resulted in a missed diagnosis.Regarding the treatment of cryptococcosis , clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin
cryptococcosis 15858 symptoms and amphotericin B plus flucytosine followed by fluconazole for severe symptoms or disseminated cryptococcosis [[23]]. A recent study proposed that surgical resection of pulmonary cryptococcoma in patients with
cryptococcosis 16089 meningitis may improve the prognosis [[24]]. Also, another group came to the conclusion that pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy [[25]]. The treatment of pulmonary
cryptococcosis 16209 resolves in most patients with or without specific antifungal therapy [[25]]. The treatment of pulmonary cryptococcosis is totally different from that of adenocarcinoma. Misdiagnosis could lead to delayed treatment, resulting
cryptococcosis 16581 pulmonary multiple nodules on the basis of CT examination. It reminded us of the possibility of pulmonary cryptococcosis coexisting with adenocarcinoma, even though pathology showed Cryptococcus infection and antifungal therapy
meningitis 15986 recent study proposed that surgical resection of pulmonary cryptococcoma in patients with cryptococcal meningitis may improve the prognosis [[24]]. Also, another group came to the conclusion that pulmonary cryptococcosis
pneumonia 555 radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as
pneumonia 2237 radiographic features. The differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes hard. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant
pneumonia 12574 masses [[17]], making it difficult to distinguish cryptococcosis from malignant tumor and bacterial pneumonia . It has been reported that among cases of pulmonary cryptococcosis coexisting with lung cancer, adenocarcinoma
pulmonary cryptococcosis 639 tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis
pulmonary cryptococcosis 739 pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented.Case presentationA 52-year-old immunocompetent Han Chinese woman
pulmonary cryptococcosis 1004 department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to
pulmonary cryptococcosis 1265 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis,
pulmonary cryptococcosis 1521 and probably poorer prognosis.ConclusionsOur patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.BackgroundPulmonary cryptococcosis is a fungal infection due to the inhalation
pulmonary cryptococcosis 2051 nervous system through the bloodstream, depending on patients’ immune status [[3]]. The diagnosis of pulmonary cryptococcosis is challenging, given its nonspecific clinical and radiographic features. The differential diagnosis
pulmonary cryptococcosis 2316 tumor, and bacterial pneumonia is sometimes hard. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor [[3]–[5]]. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis
pulmonary cryptococcosis 2428 cryptococcosis as a malignant tumor [[3]–[5]]. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor was only presented in a few reports [[6]–[10]].In this report, we describe a case
pulmonary cryptococcosis 2614 [[6]–[10]].In this report, we describe a case of an immunocompetent woman who was first diagnosed with pulmonary cryptococcosis by percutaneous lung biopsy. But after 6-month antifungal therapy, a part of her lesions was not resolved,
pulmonary cryptococcosis 5631 had not resolved, and patchy consolidation was reported, suggesting that another diagnosis, such as pulmonary cryptococcosis , secondary pulmonary tuberculosis, or malignant tumor, should be taken into consideration. After that,
pulmonary cryptococcosis 6153 granulomatous inflammation, and periodic acid-Schiff (PAS) staining showed red-colored yeast walls, suggesting pulmonary cryptococcosis (Fig. 2). The patient was then treated with fluconazole 0.2 g twice daily, and her condition was monitored
pulmonary cryptococcosis 6521 revealed granulomatous inflammation. b Periodic acid-Schiff stains the yeast wall a red color, suggesting pulmonary cryptococcosis During 6-month treatment with fluconazole, the patient underwent CT examination a total of four times,
pulmonary cryptococcosis 9448 assessment. Gefitinib has been continued.Discussion and conclusionsOur patient was finally diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. She was immunocompetent without any history of contact with poultry
pulmonary cryptococcosis 9766 time, the pathological report was granulomatous inflammation, and PAS staining was positive, suggesting pulmonary cryptococcosis . Fluconazole was used for 6 months, and the lesions partly resolved. The second biopsy of another lesion
pulmonary cryptococcosis 9928 and the lesions partly resolved. The second biopsy of another lesion was performed 10 months after pulmonary cryptococcosis was diagnosed, revealing adenocarcinoma. Postoperative pathology showed metastasis in lymph nodes, suggesting
pulmonary cryptococcosis 10850 hematologic malignancies, diabetes mellitus, hepatic cirrhosis, among others [[12], [13]]. In China, pulmonary cryptococcosis ranked as the third most common pulmonary fungal infection, and most Chinese patients with pulmonary
pulmonary cryptococcosis 10966 cryptococcosis ranked as the third most common pulmonary fungal infection, and most Chinese patients with pulmonary cryptococcosis do not have underlying diseases [[14]]. Our patient was an immunocompetent patient without an immunity-associated
pulmonary cryptococcosis 11137 patient was an immunocompetent patient without an immunity-associated medical history.The pathogen of pulmonary cryptococcosis is the following two subspecies of the Cryptococcus family: C. neoformans and C. gattii. They are abundant
pulmonary cryptococcosis 11714 We had no idea about when and where she was incidentally infected by spores.The common symptoms of pulmonary cryptococcosis are cough, fever, pleuritic pain, dyspnea, hemoptysis, fatigue, and weight loss [[16]], all of which
pulmonary cryptococcosis 11933 which are symptoms overlapping the clinical features of lung cancer. Immunocompetent patients with pulmonary cryptococcosis usually have cough as their only symptom, and one-fourth remain asymptomatic [[11]], which makes it
pulmonary cryptococcosis 12326 differential diagnoses should be considered according to her clinical symptoms.The radiographic features of pulmonary cryptococcosis are also atypical. The common CT manifestations of pulmonary cryptococcosis were solitary or multiple
pulmonary cryptococcosis 12402 radiographic features of pulmonary cryptococcosis are also atypical. The common CT manifestations of pulmonary cryptococcosis were solitary or multiple pulmonary nodules or masses [[17]], making it difficult to distinguish cryptococcosis
pulmonary cryptococcosis 12626 cryptococcosis from malignant tumor and bacterial pneumonia. It has been reported that among cases of pulmonary cryptococcosis coexisting with lung cancer, adenocarcinoma is the main histological type, probably because cryptococcosis
pulmonary cryptococcosis 13045 Pleural effusion and lymphadenectasis sometimes occur as well [[20]]. Many case reports describe that pulmonary cryptococcosis mimicked lung cancer [[3]–[5], [21]]. In our patient’s case, however, pulmonary cryptococcosis was
pulmonary cryptococcosis 13144 pulmonary cryptococcosis mimicked lung cancer [[3]–[5], [21]]. In our patient’s case, however, pulmonary cryptococcosis was coexistent with adenocarcinoma, which is rarely reported. On the basis of her CT examination, we
pulmonary cryptococcosis 13659 finally diagnosed as adenocarcinoma (Fig. 1a). We supposed that adenocarcinoma occurred earlier than pulmonary cryptococcosis . It was reported that malignant tumor might lead to immunodeficiency and result in cryptococcosis [[9]].Laboratory
pulmonary cryptococcosis 13861 result in cryptococcosis [[9]].Laboratory tests are helpful for diagnosing respiratory diseases. But in pulmonary cryptococcosis , laboratory tests such as white blood count, CRP, and renal and liver function, are usually normal.
pulmonary cryptococcosis 14083 normal. We believe that tumor markers may be the main points of interest in laboratory tests to identify pulmonary cryptococcosis and malignant tumor. Serum cryptococcal antigen titer is often used to diagnose cryptococcosis [[1]].
pulmonary cryptococcosis 15393 granulomatous inflammation with positive PAS staining, consistent with the classic manifestation of pulmonary cryptococcosis [[2]]. Taking pathological results as a gold standard, owing to the regression of one of the lesions
pulmonary cryptococcosis 16079 cryptococcal meningitis may improve the prognosis [[24]]. Also, another group came to the conclusion that pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy [[25]]. The treatment of pulmonary
pulmonary cryptococcosis 16199 cryptococcosis resolves in most patients with or without specific antifungal therapy [[25]]. The treatment of pulmonary cryptococcosis is totally different from that of adenocarcinoma. Misdiagnosis could lead to delayed treatment, resulting
pulmonary cryptococcosis 16571 of pulmonary multiple nodules on the basis of CT examination. It reminded us of the possibility of pulmonary cryptococcosis coexisting with adenocarcinoma, even though pathology showed Cryptococcus infection and antifungal therapy
pulmonary tuberculosis 5667 consolidation was reported, suggesting that another diagnosis, such as pulmonary cryptococcosis, secondary pulmonary tuberculosis , or malignant tumor, should be taken into consideration. After that, a tuberculosis infection T-cell
tuberculosis 510 Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis , malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on
tuberculosis 2192 given its nonspecific clinical and radiographic features. The differential diagnosis with secondary tuberculosis , malignant tumor, and bacterial pneumonia is sometimes hard. Many case reports have focused on misdiagnosis
tuberculosis 5677 reported, suggesting that another diagnosis, such as pulmonary cryptococcosis, secondary pulmonary tuberculosis , or malignant tumor, should be taken into consideration. After that, a tuberculosis infection T-cell
tuberculosis 5761 secondary pulmonary tuberculosis, or malignant tumor, should be taken into consideration. After that, a tuberculosis infection T-cell spot test (T-SPOT.TB; Oxford Immunotec, Marlborough, MA, USA) and tests for autoimmune

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