PULMONARY COINFECTION WITH C. NEOFORMANS AND C. IMMITIS MIMICKING MALIGNANCY

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cryptococcus neoformans and Coccidioides immitis are important opportunistic mycoses. C. is widely found in soil bird droppings while endemic to the southwestern US. These infections behave more aggressively immunocompromised hosts may present as pulmonary nodules mimicking malignancy. We a case of nodule revealing coinfection with both CASE PRESENTATION: A 47-year-old male was brought ED due erratic behavior. He hemodynamically stable, but had choreoathetoid movements, lip smacking garbled speech. history polysubstance abuse, baseline chorea unknown etiology, HIV not on ART. vacation from California. Initial chemistries were normal. UDS positive for amphetamines methamphetamines. CT brain showed global cerebral atrophy. RPR positive. Due concern CNS infection, LP performed. Opening pressure CSF studies MRI revealed caudate atrophy concerning neurodegenerative disease. On hospital day 2, patient febrile 102.7 degrees F associated nonproductive cough. CXR pneumonic consolidation LLL well-defined RLL nodule. Broad spectrum antibiotics initiated. confirmed pleural based mass measuring 2.4x2.2 cm guided lung biopsy benign parenchyma extensive necrosis. GMS stain two morphologically distinct fungal species consistent coinfection. Oral fluconazole initiated improvement his clinical condition. His speech improved throughout hospitalization. Underlying Huntington's disease exacerbated by amphetamine use suspected. DISCUSSION: Pulmonary cryptococcosis rare, representing 20% infections. In immunocompetent hosts, it consolidation, reticulonodular process, or that mimics cancer. those altered immune function, establish latent infection through persistence within granulomas cause disseminated disease, such meningitis. Similarly, usually causes severe pneumonia patients. non-immunocompromised patients, coccidiomycosis presents similarly bacterial CAP cough, fever (75%). However, thoracic manifestations variable include nodules, cavities, peribronchial thickening. caused be FDG-PET imaging, further CONCLUSIONS: Our literature review returned no prior reports immitis. postulate occurred impaired host function geographic prevalence organisms. REFERENCE #1: Setianingrum F, Rautemaa-Richardson R, Denning DW. cryptococcosis: pathobiology aspects. Med Mycol. 2019 Feb 1;57(2):133-150. doi: 10.1093/mmy/myy086. PMID: 30329097. #2: Panel Opportunistic Adults Adolescents HIV. Guidelines prevention treatment adults adolescents HIV: recommendations Centers Disease Control Prevention, National Institutes Health, Medicine Association Infectious Diseases Society America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed April 20th, 2021. #3: Jude CM, Nayak NB, Patel MK, Deshmukh M, Batra P. Coccidioidomycosis: Pictorial Review Radiographic Findings. RadioGraphics. 2014;34(4):912-925. doi:10.1148/rg.344130134 DISCLOSURES: disclosure file Nuwan Gunawardhana; No relevant relationships Anneka Hutton, source=Web Response Meagan Mayo, Gabriel Sandkovsky,