Pulmonary cryptococcoma is a localized and rare form of infection by Cryptococcus spp., frequently associated with C. gattii in immunocompetent individuals. It presents as a pulmonary nodule or mass, which may mimic neoplastic processes or tuberculosis, making diagnosis challenging. a 50-year-old male patient, previously healthy, sought medical care for dry cough, chest pain and a 5-kg weight loss over three months. He denied associated fever, night sweats or hemoptysis. Physical examination showed no significant abnormalities. Chest radiograph revealed a pulmonary nodule in the upper lobe of the right lung. Chest computed tomography showed a 3.5-cm mass with no associated lymphadenopathy. Given the diagnostic hypothesis of neoplasia, lung biopsy was performed, and histopathological examination demonstrated a granulomatous process with encapsulated yeasts stained by mucicarmine, compatible with cryptococcoma. HIV serology was negative and no other immunosuppressive condition was identified. Lumbar puncture was performed to rule out central nervous system involvement, and cerebrospinal fluid analysis was normal. Treatment with fluconazole 400 mg/day was initiated for six months, with good clinical evolution and resolution of the lesion on follow-up CT. Isolated pulmonary cryptococcoma, although rare, should be considered in the differential diagnosis of pulmonary nodules, especially in endemic regions. Diagnosis is generally established through histopathological examination. Oral antifungal therapy may be effective in mild to moderate cases; however, surgical resection is recommended in patients with large and surgically accessible pulmonary cryptococcomas, or in those with persistent symptoms and active or progressive radiologic changes despite antifungal therapy. This case highlights the importance of considering granulomatous infectious etiologies in immunocompetent patients with a pulmonary nodular lesion as a differential diagnosis of neoplasia, ensuring appropriate treatment.
Pessanha et al. (Sun,) studied this question.