Pulmonary Cryptococcosis

A previously healthy 46-year-old male referred to the hospital with low-grade fever and loss of appetite, as well as a productive cough with clear expectoration for three months. He was a chronic smoker (20 pack-years) and worked in close contact with soil and poultry. On admission, he was eutrophic and the rest of his physical examination was unremarkable. Routine laboratory exploration yielded results within normal ranges. Additionaly, sputum examination was negative for microorganisms and malignat cells. On the other hand, plain chest radiography revealed nodularity in the right lower lobe (not shown). With clinical suspicion of primary malignant lesion associated with smoking, a percutaneous pulmonary biopsy was performed and the samples were sent for histopathological evaluation. Microscopy with Hematoxylin and eosin (H&E) staining showed oval to round thick-walled microorganisms within the alveoli surrounded by conspicuous non-stained clear mucoid capsules, whereas melanin was detected in the cell wall of these agents by Fontana-Masson method. Microorganisms were metachromatically stained by toluidine blue staining, except their capsules (Figures 1A and 1B), and the etiological diagnosis was established. The nodular lesion of the lung was excised (Figure 1C), and the patient underwent long-term antimicrobial treatment.