Endobronchial cryptococcosis induced by Cryptococcus gattii mimicking metastatic lung cancer

A 41-year-old previously healthy Japanese man complained of cough for 2 months. A chest computed tomography scan revealed a mass in his left lung with multiple mediastinal lymphadenopathy. Brain magnetic resonance imaging showed many small, enhancing lesions. He was admitted to our hospital for further evaluation of an abnormal shadow suspicious for metastatic lung cancer. Bronchoscopy showed aggregated white nodes in the compressively stenosed left main bronchus. A specimen from transbronchial biopsy showed many foamy and yeast-like cells. Cultures and additional gene analysis identified these cells as Cryptococcus gattii. Antifungal treatment was commenced and his symptoms clearly improved. To our knowledge, this is the first case of an aggressive form of endobronchial cryptococcosis caused by C. gattii.