Objective: Pulmonary cryptococcosis typically occurs in immunocompromised patients, but can also occur in immunocompetent patients. According to the host‘s immune status, inhaled spores may remain dormant in the lung or may spread to other parts. Thus, clinical manifestations of crytococcosis can be highly variable, from asymptomatic pulmonary disease to life-threatening meningitis depending on the immunity. Our objective was to describe the clinical manifestations, radiologic findings, management and prognosis of pulmonary cryptococcosis in immunocompetent patients.
Methods: We retrospectively analyzed 12 cases of immunocompetent patients with pathologically proven pulmonary cryptococcosis during ten years.
Results: Mean patients age was 50 years (20-72 years) and 6 patients were male. The major clinical manifestations were cough (4 patients), chest pain (3 patients), and hemoptysis (1 patients). Four patients were asymptomatic. On CT findings, 10 patients showed single or multiple nodules (7 patients vs 3 patient), while 2 patients showed multiple consolidations. One patient was diagnosed by open lung biopsy, 11 patients by needle biopsy. Eight patients were treated with oral fluconazole and 2 patients with itraconazole. Seven patients of 10 patients with treatment with oral antifungal agents showed completed resolution, 2 patients showed partial resolution, and one patient showed no interval change. During follow-up period, all patients showed favourable outcome without relapse.
Conclusion: These results suggest that pulmonary crypotoccosis was found in all-aged immunocompetent patients with no or mild symptoms. Also treatment with oral fluconazole or itraconazole could achieve favorable outcome.