Abstract Introduction Cryptococcus neoformans is an opportunistic fungal infection typically seen in immunocompromised individuals but increasingly reported in immunocompetent hosts. Misdiagnosed as bacterial pneumonia, tuberculosis, or lung cancer, leading to delayed treatment. Risk factors include environmental exposures “dust inhalation, pigeon droppings, and decaying organic matters inhalations”, occupational exposures “poultry industry, construction work, and farming”, medications use include corticosteroids therapy and biologic therapies and immunocompromised states as in patients with HIV/AIDS, organ transplant recipients or malignancies. Case Presentation A 47-year-old female with newly diagnosed with neurofibromatosis, depression, and hypertension. She works at a poultry sanitation, and recently travelled to Puerto Rico. She denied fever, chills, hemoptysis, weight loss, recent sick contact. She presented to the emergency department a month ago for evaluation of acute shortness of air, chest tightness, and dry cough and diagnosed with double pneumonia and was given IM shot and discharged on oral Cefdinir. She visited her Primary physician “PCP” a week after antibiotic completion due to worsening shortness of breath and chest discomfort and was given another IM shot and a week of oral Doxycycline. At this time, patient was cleared to go back to work in poultry sanitation. Due to unresolved symptoms, seen by PCP with worsening cough and fatigue and got a steroid shots. A week later, patient returned to PCP with worsening SOA. Imaging showed worsening multifocal pneumonia for which she got admitted for evaluation. Laboratory data showed that both CBC with differential and chemisteries were unremarkable. Inflammatory markers showed CRP 5.8, ESR 136, and Procalcitonin 0.065. Serum cryptococcal antigen test positive confirming infection, alongside a negative HIV test, indicating cryptococcosis in an immunocompetent patient. Discussion Cryptococcal pneumonia can mimic bacterial or atypical infections in the lung. It can present with nonspecific respiratory symptoms including dyspnea, cough, or chest pain. It has variable CT scan findings not limited to nodules, masses or cavitary lung lesion. Usually serum antigen is negative, and definitive diagnosis needs BAL. Conclusion Pulmonary cryptococcosis is often misdiagnosed as bacterial pneumonia, tuberculosis, or malignancy in immunocompetent individuals, leading to delays in treatment. Exposure risks (e.g. poultry sanitation, construction, soil/dust) and geographic prevalence should raise suspicion in certain cases. Imaging alone is insufficient for diagnosis due to variability (nodules, masses, cavitary lesions). BAL and fungal cultures are essential. Early recognition improves outcomes and prevents cavitation, fibrosis, and CNS dissemination. Standard treatment: Amphotericin B plus Flucytosine induction, followed by oral Fluconazole for long-term suppression. This abstract is funded by: None
Arzoun et al. (Fri,) studied this question.