Pulmonary Cryptococcosis with Eosinophilic Granuloma of the Rib Mimicking Advanced Lung Cancer

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  • Takeshita Shinji
    Department of Cardiovascular, Respiratory, General Surgery, Nihon University School of Medicine Musashino General Hospital
  • Muramatsu Takashi
    Department of Cardiovascular, Respiratory, General Surgery, Nihon University School of Medicine
  • Tanaka Yoko
    Department of Cardiovascular, Respiratory, General Surgery, Nihon University School of Medicine
  • Shiono Motomi
    Department of Cardiovascular, Respiratory, General Surgery, Nihon University School of Medicine

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Other Title
  • 進行肺癌との鑑別が困難であった肋骨好酸球性肉芽腫症を合併した肺クリプトコッカス症
  • 症例報告 進行肺癌との鑑別が困難であった肋骨好酸球性肉芽腫症を合併した肺クリプトコッカス症
  • ショウレイ ホウコク シンコウ ハイガン ト ノ カンベツ ガ コンナン デ アッタ ロッコツ コウサンキュウセイ ニクガシュショウ オ ガッペイ シタ ハイ クリプトコッカスショウ

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Abstract

A forty year-old man was admitted to our hospital complaining of right anterior chest pain. Chest computed tomograms showed a 10 X 10-mm mass in the right middle lobe of the lung. Positron emission tomography (PET) showed hot regions (SUV MAX 6.28 and 4.35, respectively) in the right middle lobe of the lung and in the sixth rib on the right side. We suspected primary lung cancer with a rib metastasis. The patient underwent bronchoscopic examination and rib biopsy. However, a definitive diagnosis was not established. Because there were no obvious metastatic lesions in any other organs, right middle lobectomy and costectomy of the sixth rib were performed to establish the diagnosis. The pathologic findings were compatible with coexistence of pulmonary cryptococcosis and eosinophilic granuloma of the rib. After the operation, the clinical course was uneventful without antifungal prophylaxis. Ten months after the operation, the patient has shown no signs of recurrence.

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