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Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent

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  • 1 Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, New York;
  • | 2 Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, New York
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ABSTRACT.

Cryptococcus exposure in certain global regions is common and yet virulence in the immunocompetent host remains rare. Radiological findings of pulmonary cryptococcosis may include nonspecific lung nodules or masses indistinguishable from lung cancer or pulmonary tuberculosis. We present a case of an immunocompetent diabetic female who presented with progressively worsening pleuritic chest pain and cough with travel between Tibet and New York 2 months earlier. Chest imaging demonstrated a large lobulated mass, acid-fast bacillus smears were negative, and our patient underwent pulmonary biopsy, which grew rare budding yeast later confirmed by mucicarmine staining as Cryptococcus. Our patient was successfully treated with fluconazole therapy. We hypothesize that the high altitude of Tibet may allow for clinical latency followed by symptomatic reactivation on descent. A raised index of suspicion for pulmonary cryptococcosis with careful attention to travel history is expected to facilitate timely diagnosis.

Author Notes

Address correspondence to Keely Johnson, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373. E-mail: keelyjohnsonmd@gmail.com

Authors’ addresses: Keely Johnson, Umaima Dhamrah, and Aisha Amin, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, E-mails: keelyjohnsonmd@gmail.com, dhamrahumaima@gmail.com, and aisha.aminh@gmail.com. Joseph Masci, Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, E-mail: mascij@nychhc.org.

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