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Case Report
Diagnosis of Cryptococcus neoformans in a soft tissue mass by fine needle aspiration in an immunocompetent patient
1 Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
2 Department of Pathology, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
3 Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
Address correspondence to:
Negin Farsi
Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee,
USA
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Article ID: 100058Z11NF2022
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Farsi N, Mirza R, Siriwardane N, Flowers A. Diagnosis of Cryptococcus neoformans in a soft tissue mass by fine needle aspiration in an immunocompetent patient. J Case Rep Images Pathol 2022;8:100058Z11NF2022.ABSTRACT
Introduction: Cryptococcus neoformans is an encapsulated fungus present in the environment that primarily affects immunocompromised patients. Disseminated cryptococcosis is usually seen in immunocompromised patients and rarely in immunocompetent patients. It commonly involves the lung and central nervous system. Skeletal cryptococcosis is very rare. We present an interesting case of disseminated cryptococcosis with multiple lytic lesions of bone and a soft tissue mass in an immunocompetent patient. This type of clinical presentation in an immunocompetent person is extremely rare based on the English literature review.
Case Report: Our patient presented with worsening left knee pain over the past four months and swelling of the popliteal fossa of the left knee. He also complained of unintentional weight loss of 20–30 lbs, loss of appetite, night sweats, subjective fever, and chills. A computed tomography (CT) scan revealed an aggressive appearing soft tissue mass in the popliteal area infiltrating into adjacent bone, a lytic lesion in iliac crest, and one small lung nodule. Fine needle aspiration of knee mass revealed numerous fungal yeast forms. Morphology and ancillary tests were diagnostic of C. neoformans. Further workup revealed disseminated cryptococcosis despite of negative workup for immunodeficiency. The patient was treated with antifungal therapy and responded well.
Conclusion: Our article describes a rare presentation of disseminated cryptococcal infection and emphasizes the importance of considering cryptococcal infection as one of the differential diagnosis in any bone or soft tissue mass even in an immunocompetent patient.
Keywords: Cryptococcus, Fine needle aspiration, Immunocompetent, Knee pain
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Author Contributions
Negin Farsi - Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Rusella Mirza - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Neesha Siriwardane - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ashley Flowers - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Negin Farsi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
