CTICasesCryptococcus gattii Presenting as Solitary Lung Nodule with Leptomeningitis
Imaging findings
Chest CT demonstrates a solitary mass in the right lower lobe displacing adjacent airway, with no other pulmonary abnormalities or mediastinal adenopathy. Brain MRI shows leptomeningeal enhancement in the sulci of the cerebellum and cerebrum on post-contrast T1, with corresponding FLAIR signal changes at the cortical margin, consistent with leptomeningitis. Biopsy of the lung nodule grew Cryptococcus gattii, a species previously thought to be restricted to the Pacific Northwest tree fungus reservoir.
Key takeaways
Cryptococcus gattii, unlike C. neoformans, can infect immunocompetent hosts and was historically restricted to the Pacific Northwest and tropical regions where it colonizes trees. CDC reports have documented cases of C. gattii infection in immunocompetent patients outside the Northwest including east of the Mississippi, suggesting geographic spread possibly via migratory birds. The clinical and imaging presentation of C. gattii resembles C. neoformans: solitary or multiple pulmonary nodules combined with leptomeningeal spread. In non-immunocompromised patients from non-endemic areas with a solitary pulmonary nodule and neurologic symptoms, Cryptococcus should be on the differential.
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