CTICasesPulmonary Cryptococcosis in a Solid Organ Transplant Recipient
Imaging findings
Chest CT in a solid organ transplant recipient demonstrates a single, irregular, ragged nodule in the left upper lobe. PET/CT shows intense FDG avidity within the nodule, mimicking post-transplant lymphoproliferative disorder (PTLD) or primary lung bronchogenic carcinoma. CT-guided fine-needle aspiration and biopsy confirmed tissue-invasive Cryptococcus infection.
Key takeaways
In immunosuppressed patients, particularly solid organ transplant recipients, opportunistic fungal pathogens like Cryptococcus, Aspergillus, and Nocardia are high-priority considerations for new, progressive, or FDG-avid pulmonary nodules. Tissue biopsy (such as CT-guided needle biopsy) is often required to establish a diagnosis, as bronchoalveolar lavage can yield false-negative results if the fungal organisms are strictly tissue-invasive and not present in the airspaces.
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