Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated pulmonary cryptococcosis

Abstract

Background: Previous studies have demonstrated that the most common chest radiologic finding in acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) is diffuse interstitial infiltrates. The aim of this study was to provide additional radiologic characterization of PC in AIDS patients. Methods: AIDS patients from the Second Affiliated Hospital of the Southeast University who were diagnosed with cryptococcosis between February 2009 and May 2012 and who had undergone chest computed tomography (CT) scans before or at the time of diagnosis were retrospectively analyzed. Results: Twelve patients met eligibility criteria. The median CD4 T-cell count was 23 cells/μl (range 2–79 cells/μl). Eleven patients had pulmonary abnormalities on imaging. Initial chest CT scans demonstrated solitary cavitary pulmonary nodules in 9 patients, pleural effusions in 2 patients, bilateral ground-glass opacities in 6 patients, patchy opacities in 1 patient, and bronchiectasis in 1 patient. Bilateral ground-glass opacities appeared to be associated with Pneumocystis pneumonia, while the presence of a pleural effusion was predictive of PC. Of the 9 solitary cavitary pulmonary nodules, 7 were PC and the other 2 were probable cases of PC. These nodules were predominantly in the peripheral lung and were either asymptomatic or caused only mild pulmonary symptoms. Conclusions: Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated PC. All AIDS patients with solitary cavitary pulmonary nodules on chest CT should be screened for Cryptococcus infection.

Keywords::

• Pulmonary cryptococcosis
• AIDS
• radiologic characteristic
• solitary cavitary pulmonary nodule

Acknowledgements

We thank Felicia Chow, MD at the University of California, San Francisco (UCSF) for assistance with editing the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This research was funded in part by grant YKK10053 from the Nanjing Medical Science and Technique Development Foundation.