Pulmonary and meningeal cryptococcosis caused by Cryptococcus gattii in an immunocompetent patient: a case report.

Abstract

Introduction: Cryptococcosis is a systemic mycosis associated with high morbidity and mortality, traditionally linked to immunocompromised individuals, particularly people living with HIV. However, infections caused by Cryptococcus gattii have increasingly been described in immunocompetent individuals, often presenting with atypical clinical features that may hinder early diagnosis. Objective: To describe a case of pulmonary and meningeal cryptococcosis in an immunocompetent patient, highlighting diagnostic challenges and clinical evolution. Case report: A 58-year-old immunocompetent male, living in an urban area, with a history of occasional activities involving cleaning of warehouses and water tanks, presented with chest pain, fever, and dyspnea, later progressing to severe headache. Imaging studies revealed an expansive pulmonary lesion with pseudotumoral features, initially suggestive of neoplasia. Microbiological investigation, including cerebrospinal fluid analysis and fungal culture, confirmed pulmonary cryptococcosis associated with cryptococcal meningitis, with identification of Cryptococcus gattii. The patient received antifungal therapy according to guidelines, showing initial microbiological response; however, clinical deterioration ensued, requiring surgical intervention and resulting in a fatal outcome. Conclusion: This case highlights that cryptococcosis caused by C. gattii should be considered in the differential diagnosis of pseudotumoral pulmonary lesions in immunocompetent patients, as it may present with severe progression despite appropriate treatment, underscoring the importance of early diagnosis.