RADIOLOGICAL DIAGNOSIS
Diagnosis of the case presented in the previous edition
Dany Jasinowodolinski; Gustavo de Souza Portes Meirelles; Flavio Duarte Silva; Nestor L Müller
Fleury Center for Diagnostic Medicine, São Paulo, Brazil; Universidade Federal de São Paulo UNIFESP, Federal University of São Paulo São Paulo, Brazil; Universidade Federal de São Paulo UNIFESP, Federal University of São Paulo São Paulo, Brazil; University of British Columbia, Vancouver, BC, Canadá; University of British Columbia Vancouver, British Columbia, Canada
Criptococose pulmonar
Comments
Contamination with the fungus Cryptococcus neoformans usually occurs via inhalation. The pulmonary infection (cryptococcosis) can be asymptomatic, at times self-limited, or it can be severe and progressive. A study involving immunocompetent patients revealed that half of the patients reported cough or chest pain, one-fourth presented weight loss, and one-fourth were asymptomatic. The results of imaging studies can vary. Immunocompetent patients generally present mild pulmonary symptoms, tending to present nodules that simulate pulmonary tuberculosis or even neoplasms. Immunocompromised patients typically present nodules and multiple consolidations and can also present lung cavitation, enlargement of lymph nodes and pleural effusion.
In the case presented here, the clinical history of the patient began with systemic lupus erythematosus and evolved to severe lupus nephritis. After 38 days of immunosuppressive treatment, the patient returned to the hospital reporting fever. A chest X-ray revealed consolidation in the right lung. Computed tomography characterized the consolidation better, revealing its peripheral location and cuneiform shape based in the pleura. The diagnosis was confirmed through biopsy of the pulmonary lesion.
Referências
Readers correctly diagnosing the case presented in the September/October 2007 issue:
Elza Maria Rezende de Almeida Centro de Saúde da Policia Militar do Amapá Amapá AP
- 1. Patz EF Jr, Goodman PC. Pulmonary cryptococcosis. J Thorac Imaging. 1992;7(4):51-5.
- 2. Campbell GD. Primary pulmonary cryptococcosis. Am Rev Respir Dis. 1966;94(2):236-43.
- 3. Khoury MB, Godwin JD, Ravin CE, Gallis HA, Halvorsen RA, Putman CE. Thoracic cryptococcosis: immunologic competence and radiologic appearance, AJR, Am J Roentgenol. 1984;142(5):893-6.
- 4. Boyars MC, Zwischenberger JB, Cox CS Jr. Clinical manifestations of pulmonary fungal infections. J Thorac Imaging. 1992;7(4):12-22.
- 5. Feigin DS. Pulmonary cryptococcosis: radiologic-pathologic correlates of its three forms. AJR Am J Roentgenol. 1983;141(6):1262-72.
Publication Dates
-
Publication in this collection
15 Jan 2008 -
Date of issue
Dec 2007
