Cryptococcal meningitis with concurrent pulmonary cryptococcosis: Retrospective clinical analysis of 12 cases

The clinical and imaging characteristics of cryptococcal meningitis (CM) with concurrent pulmonary cryptococcosis (PC) were presented in the present study. Retrospective clinical data analysis of 20 histopathologically confirmed cases of CM with concurrent PC. The patients included eight males and four females, with four 62-year olds and an average age of 33.3 years ± 23.8 years. The course was from 14 days to 120 days (41.0 ± 39.9). The first symptom in ten cases was fever, eight cases had headache, three cases had productive cough and one case had chest pain. Ten cases have underlying diseases, which include six cases of chronic viral hepatitis B, three cases of silicosis with concurrent tuberculosis, one case of malnutrition, one case of systemic lupus erythematosus and one case of sinusitis. Ten of the cases were misdiagnosed as pulmonary tuberculosis, and one case was misdiagnosed as lung cancer. The chest X-rays revealed patchy, nodular shadows scattered in both lungs, with blurred edges and irregular low density areas. The computed tomography (CT) showed highly dense, patchy and speckled shadows widespread in both lungs, cavities of varying sizes, and elliptical, smooth-edged high density nodules. The cases were treated with intravenous amphotericin B (AMB) combined with fluconazole and intrathecal AMB. Eight cases were cured, whereas four cases improved. The clinical symptoms and imaging of CM with concurrent PC lack specificity. The increasing the understanding of CM imaging is beneficial to early diagnosis.   Key words: Cryptococcus neoformans meningitis, pulmonary cryptococosis, imaging.