Abstract
Background: Pulmonary cryptococcosis is a type of pulmonary mycosis that can be asymptomatic and determined only as an abnormal shadow on X-ray film. Because differentiating pulmonary cryptococcosis nodules from lung cancer is difficult, some patients must be surgically diagnosed. Furthermore, whether surgically-diagnosed pulmonary cryptococcosis should be treated remains controversial.
Objectives: The aim of this study was to evaluate whether we can differentiate pulmonary cryptococcosis from lung cancer, and it should be treated after surgery.
Methods: We retrospectively analyzed 17 patients with surgically-diagnosed pulmonary cryptococcosis at the 1135-bed Kurashiki Central Hospital (a tertiary facility), Okayama, Japan between June 1994 and November 2009.
Results: The 8 male and 9 female patients (median age, 56 years; range, 36 to 71 years) included 2 with diabetes mellitus and 2 who were treated with steroids. Eleven patients who underwent fiberoptic bronchoscopy before surgery were not diagnosed. Only one of six patients was positive for Cryptococcus antigen. The X-rays revealed nodules or a mass in all patients and none had an infiltration shadow. Thirteen patients had a single nodule. Only one patient was administered with fluconazole, 16 patients were not treated and none of the 17 patients relapsed.
Conclusions: To differentiate a single nodule of pulmonary cryptococcosis from lung cancer was difficult, rendering surgery as the sole definitive diagnostic option. None of our patients relapsed including four who were immunocompromised, indicating that treatment is not a necessary component of follow-up after surgical diagnosis of pulmonary cryptococcosis.
- © 2011 ERS