Large Pulmonary Cryptococcoma and Cryptococcal Meningitis in an Immunocompetent Patient: A Case Report Ranbeer Singh, M.D., Deepti Joshi, M.D., Anupama Gupta, M.D., and Nitin Gangane, M.D., D.N.B. * Pulmonary cryptococcoma is a life threatening mycosis and is an unusual disease for immunocompetent individuals. Herein we report a case of large pulmonary cryptococcoma associated with cryptococcal meningitis, presenting radiologically as a lung mass in right upper lobe, in a previously healthy, HIV negative, immunocompetent young individual. Since cryptococcosis contin- ues to be an important infection in HIV negative patients and is associated with substantial overall and cause-specific mortality, the need for consideration of this entity in the differential diag- nosis of a lung mass is emphasized. Diagn. Cytopathol. 2010;38:929–931. ' 2010 Wiley-Liss, Inc. Key Words: cryptococcoma; HIV C. neoformans is a ubiquitous pathogenic encapsulated yeast that causes human diseases ranging from asymptom- atic pulmonary colonization to fatal meningitis and over- whelming cryptococcimia. 1,2 Pulmonary cryptococcoma is a life threatening mycosis and is an unusual disease for immunocompetent individuals. Chest radiograph shows varying pictures and the commonest appearance is a round shadow usually in the lower lobe without any enlarged hilar shadow, less common radiological findings are diffuse miliary shadows, or areas of consolidation. 3,4 Disease may occur in healthy hosts, but the majority of the patients are apparently immunocompromised, having significant underlying predisposing factors such as advance HIV disease, hematological malignancies, sar- coidosis, solid organ transplantation, tuberculosis, and corticosteroid treatment. 5–8 Particularly HIV infection has emerged as the leading cause of immunodeficiency predis- posing to cryptococcal infection. However, 10–40% HIV negative patients with cryptococcosis have no apparent immune deficiency, although selective defects in lympho- cytes responsiveness to C. neoformans or other subtle abnormalities may explain disease occurrence in other- wise normal hosts. 9–14 Common presentation of crypto- coccosis are related to pulmonary, central nervous system (CNS) and skin involvement. We present a case of pul- monary cryptococcoma with cryptococcal meningitis in an immunocompetent young individual. Case Summary A 32-year-old male patient was admitted to the hospital with the complaints of fever, dyspnea, chest pain, and cough for a duration of 3 months. Fever was moderate grade, intermittent without any localizing features. There was also history of anorexia and significant weight loss over past 3 months. There was no history of hemoptysis, hemetemesis, melena, abnormal behavior or movements, dysuria, oligouria or hematuria, blood transfusion, multi- ple injections in past, drug abuse or contact with commer- cial sex worker. There was no history to suggest diabetes mellitus or tuberculosis. However, he subsequently devel- oped neck rigidity during hospital stay. On examination, the patient was a thin built male with mild pallor, and crepitations on right side of chest. There was no organomegaly and the rest of the general as well as systemic examination was unremarkable. Hematologi- cal investigations, renal function tests, urine examination and liver function tests were within normal limits. Serol- ogy for HBsAg, anti-HCV and anti HIV-1 and HIV-2 was negative. Chest X-ray showed a well circumscribed shadow (mass lesion) in the upper lobe of right lung (Fig. 1). USG thorax showed evidence of solid hypoechoic area in the right upper lobe of lung with minimal air Department of Pathology, Mahatma Gandhi Institute of Medical Scien- ces, Sevagram, Wardha, Maharashtra, India *Correspondence to: Nitin Gangane, M.D., D.N.B., Professor and Head, Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India. E-mail: nitingangane@rediffmail.com Received 25 September 2009; Accepted 23 December 2009 DOI 10.1002/dc.21345 Published online 18 March 2010 in Wiley Online Library (wileyonlinelibrary.com). ' 2010 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 38, No 12 929