Pleural fluid secondary to pulmonary cryptococcal infection: A case report and review of the literature

Yuan Zhang, Sean X. Zhang, Julie Trivedi, Adam D. Toll, Julie Brahmer, Russell Hales, Sarah Bonerigo, Mingying Zeng, Huiping Li, Rex C. Yung

Research output: Contribution to journalArticle

Abstract

Background: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.

Original languageEnglish (US)
Article number710
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
StatePublished - Aug 12 2019
Externally publishedYes

Fingerprint

Lung
Infection
Pleural Effusion
Cryptococcosis
Fluconazole
Non-Small Cell Lung Carcinoma
Dyspnea
Radiotherapy
Antigens
Neoplasms
Cryptococcus neoformans
Incidence
Fluorodeoxyglucose F18
Bronchoscopy
Positron-Emission Tomography
Yeasts
HIV
Biopsy
Therapeutics
Growth

Keywords

  • Crytococcal antigen
  • Lateral flow assay
  • Pleural effusion
  • Pulmonary cryptococcosis

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Pleural fluid secondary to pulmonary cryptococcal infection : A case report and review of the literature. / Zhang, Yuan; Zhang, Sean X.; Trivedi, Julie; Toll, Adam D.; Brahmer, Julie; Hales, Russell; Bonerigo, Sarah; Zeng, Mingying; Li, Huiping; Yung, Rex C.

In: BMC Infectious Diseases, Vol. 19, No. 1, 710, 12.08.2019.

Research output: Contribution to journalArticle

Zhang, Y, Zhang, SX, Trivedi, J, Toll, AD, Brahmer, J, Hales, R, Bonerigo, S, Zeng, M, Li, H & Yung, RC 2019, 'Pleural fluid secondary to pulmonary cryptococcal infection: A case report and review of the literature', BMC Infectious Diseases, vol. 19, no. 1, 710. https://doi.org/10.1186/s12879-019-4343-2
Zhang, Yuan ; Zhang, Sean X. ; Trivedi, Julie ; Toll, Adam D. ; Brahmer, Julie ; Hales, Russell ; Bonerigo, Sarah ; Zeng, Mingying ; Li, Huiping ; Yung, Rex C. / Pleural fluid secondary to pulmonary cryptococcal infection : A case report and review of the literature. In: BMC Infectious Diseases. 2019 ; Vol. 19, No. 1.
@article{b13a14d11f944d5d86ce2082e8273624,
title = "Pleural fluid secondary to pulmonary cryptococcal infection: A case report and review of the literature",
abstract = "Background: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.",
keywords = "Crytococcal antigen, Lateral flow assay, Pleural effusion, Pulmonary cryptococcosis",
author = "Yuan Zhang and Zhang, {Sean X.} and Julie Trivedi and Toll, {Adam D.} and Julie Brahmer and Russell Hales and Sarah Bonerigo and Mingying Zeng and Huiping Li and Yung, {Rex C.}",
year = "2019",
month = "8",
day = "12",
doi = "10.1186/s12879-019-4343-2",
language = "English (US)",
volume = "19",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Pleural fluid secondary to pulmonary cryptococcal infection

T2 - A case report and review of the literature

AU - Zhang, Yuan

AU - Zhang, Sean X.

AU - Trivedi, Julie

AU - Toll, Adam D.

AU - Brahmer, Julie

AU - Hales, Russell

AU - Bonerigo, Sarah

AU - Zeng, Mingying

AU - Li, Huiping

AU - Yung, Rex C.

PY - 2019/8/12

Y1 - 2019/8/12

N2 - Background: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.

AB - Background: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. Case presentation: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. Conclusion: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.

KW - Crytococcal antigen

KW - Lateral flow assay

KW - Pleural effusion

KW - Pulmonary cryptococcosis

UR - http://www.scopus.com/inward/record.url?scp=85070690754&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070690754&partnerID=8YFLogxK

U2 - 10.1186/s12879-019-4343-2

DO - 10.1186/s12879-019-4343-2

M3 - Article

C2 - 31405376

AN - SCOPUS:85070690754

VL - 19

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

IS - 1

M1 - 710

ER -