CTICasesCavitary Cryptococcal Pneumonia in Autoimmune Hepatitis with Cirrhosis
Imaging findings
In a middle-aged man with autoimmune hepatitis, cirrhosis, and portal hypertension, chest radiograph shows small lung volumes, ascites, and a nodular right upper lobe consolidation with a large associated pleural effusion and a dilated azygos vein from portal venous hypertension. CT the same day shows a focal area of consolidation with cavitation, abrupt margins, and an airway-centered distribution in the right upper lobe; the consolidated cavity coalesces into a single large cavitary mass on follow-up imaging after treatment.
Key takeaways
A cavitating, airway-centered consolidation that fails standard antibacterial therapy in an immunocompromised cirrhotic patient grew Cryptococcus neoformans -- a more consolidative appearance than the discrete pulmonary nodules more classically described with cryptococcosis, so a lumbar puncture should still be pursued to exclude CNS involvement in a high-risk host even when the presentation looks atypical.
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