Background

Cryptococcosis is a generally systemic and potentially lethal fungal infection. Although HIV infection is a predisposing condition, especially if the CD₄₊ lymphocyte count is less than 100 cells/mm³, other forms of immunosuppression may be associated with this opportunistic fungal condition, such as prolonged steroid therapy or solid organ transplantation. Pulmonary presentation must be included in the differential diagnosis of pneumonia or pulmonary neoplasia in the immunosuppressed patient.

Case report

We report a case of pulmonary cryptococcosis in a non-diagnosed HIV patient. In a 44 year-old male suffering from dyspnea and chest pain the image of a pulmonary nodule was observed in a radiological finding. In the histopathological study, intracellular structures suggestive of fungal conidia, and morphologically compatible with Cryptococcus, were observed. HIV serology and cryptococcal antigen detection in serum were requested, given the possibility of cryptococcosis. Cryptococcus neoformans var. grubii was isolated from the culture of the pulmonary biopsy. The patient was finally diagnosed with pulmonary cryptococcosis and HIV-1 infection. With a proper antifungal treatment the patient evolved satisfactorily.

Conclusions

The best strategy to avoid opportunistic infections such as cryptococcosis in HIV-infected patients consists of an early diagnosis and a highly active antiretroviral treatment. In our case, the diagnosis of a pulmonary infection by C. neoformans var. grubii allowed a late diagnosis of HIV-1 infection.

中文翻译：

---

肺结节：已诊断为艾滋病毒感染的异常发作。

背景

隐球菌病是一种全身性且可能致命的真菌感染。尽管HIV感染是易患病，特别是如果CD ₄₊淋巴细胞计数低于100个细胞/ mm ³，则其他形式的免疫抑制可能与这种机会性真菌病有关，例如长时间的类固醇治疗或实体器官移植。在免疫抑制患者的肺炎或肺肿瘤形成的鉴别诊断中必须包括肺部表现。

案例报告

我们报告了一名未确诊的HIV患者的肺隐球菌病病例。在一名患有呼吸困难和胸痛的44岁男性中，在放射学发现中发现了肺结节的图像。在组织病理学研究中，观察到提示真菌分生孢子的细胞内结构，并在形态上与隐球菌相容。考虑到隐球菌病的可能性，要求在血清中进行HIV血清学检查和隐球菌抗原检测。新型隐球菌变种 从肺活检的培养物中分离出绿ubi。最终该患者被诊断患有肺隐球菌病和HIV-1感染。通过适当的抗真菌治疗，患者可以令人满意地发展。

结论

在HIV感染患者中避免机会性感染（例如隐球菌病）的最佳策略包括早期诊断和高效抗逆转录病毒治疗。在我们的案例中，诊断为新孢子虫肺部感染。grubii允许晚期诊断出HIV-1感染。