Cryptococcal infection masquerading as a posterior mediastinal mass on cross sectional imaging: A case report and review of literature

Pulmonary fungal infections are typically opportunistic but can also develop in immunocompetent hosts. These infections frequently present with diverse imaging appearances, often mimicking more common pulmonary or mediastinal conditions. We report the case of a 64 year old male with cough, shortness of breath and chest heaviness whose imaging features (neural formainal extension; destruction of adjacent ribs and vertebral bodies and chest wall invasion) initially suggested a malignant peripheral nerve sheath tumor. However, biopsy performed twice confirmed the lesion to be a cryptococcal infection. This case highlights that fungal infections in immunocompetent individuals may present as invasive mass-like lesions. Consequently, infections—particularly fungal etiologies—should remain an important consideration in the differential diagnosis of thoracic masses, even in patients without overt immunosuppression.