A case of fungal pneumonia in immunocompetent patient in nonendemic area

ABSTRACT

Introduction: Cryptococcal pneumonia is predominantly seen in immunosuppressed individuals and rarely in immunocompetent population. We report a case of middle age male with Cryptococcal pneumonia. History A 45-year-old male farmer by occupation presented with shortness of breath for 2months, cough with sputum for 2 months associated with streaky hemoptysis, fever on and off for 1month, loss of appetite for 1 month, no history of SARS CoV 2, no h/o long term steroid usage and immunosuppression (HIV, malignancy) no significant family history. Presentation Spo2- 98%RA, Blood pressure and pulse rate were normal. Examination reveaed Decreased breath sounds in left infra scapular area. Rest systemic examination was normal. Diagnosis HIV, HBsAg were negative, Sputum Gram stain, KOH mount, culture was negative, Sputum CBNAAT was negative. Chest x-ray s/o non homogenous opacity in left mid zone. CT chest s/o Consolidation in superior segment of left lower lobe. Patient underwent FOB in view of hemoptysis. Bronchial washings cytology was negative, CBNAAT was negative, Fungal culture s/o Cryptococcus neoformans sensitive to amphotericin B and Flucytosine. Management Microbiology based treatment with Amphotericin B and fluconazole. Clinical Implications Any evidence of a cavitating nodule on CT in a patient presenting with cough & sob, a fungal infection is suspected irrespective of immune status and endemicity.