PMC8573811_01
Initial (A) and repeat (B) chest radiograph.
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F1
In addition, the left lower zone revealed an ill-defined area of ground glass opacification (Fig. 1A). A repeat chest radiograph in July 2019 revealed that the lesions had increased in size (Fig. 1B).
Computed tomography scan of the chest.
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F2
This was associated with pulmonary nodules and left pleural thickening (Figs 2A and B).
A photomicrograph of an H & E stain lung showing necrotising granulomatous inflammation and fibrous thickening of the pleura (A), 20x
magnification. A photomicrograph of a section stained with Alcian Blue and PAS (ABPAS) showing fungal elements with morphological features
of Cryptococcus (B).
AJTCCM-27-3-116-fig3.jpg
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F3
Owing to the peripheral nature of these lesions, she underwent a CT-guided transthoracic lung biopsy, which revealed fibrous connective tissue with evidence of chronic necrotising granulomatous inflammation and fungal organisms with the morphological features of Cryptococcus (Figs 3A and B).
Repeat chest radiograph (A) and computed tomography images 6 months after initiation of therapy (B).
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F4
Follow-up chest radiography revealed partial resolution of the lesions noted previously (Fig. 4A).  Fluconazole 200 mg twice daily for 3 months and then 200 mg daily thereafter was continued. Subsequent repeat CT imaging done 6 months after initiation of therapy revealed resolution of lung nodules and masses, with some residual fibro-cavitary lung changes remaining in areas previously involved by mass formation (Fig. 4B).