Video-assisted thoracoscopic surgery for primary pulmonary cryptococcosis

Background: The surgical outcome for primary pulmonary cryptococcosis remains unclear. In this study, we investigated the clinical characteristics, treatment, and outcomes of video-assisted thoracoscopic surgery (VATS) for primary pulmonary cryptococcosis.Methods: We retrospectively reviewed the medical records of 49 patients with confirmed pul-monary cryptococcosis who underwent VATS for pulmonary nodules at the National Taiwan Uni-versity Hospital between May 2013 and March 2019. Serum cryptococcal antigen (CryAg)-positive and CryAg-negative patients were compared.Results: The diagnosis of pulmonary cryptococcosis was confirmed using histopathology or tissue swab culture. The mean age of the patients was 56.0 +/- 12.2 years, and 27 patients (55.1%) were male. Most patients were asymptomatic (67.3%) and admitted following the detection of pulmonary lesions on a computed tomography scan of the chest. A greater pro-portion of patients in the CryAg-positive group (62.5%) underwent lobectomy compared with those in the CryAg-negative group (7.3%, P < 0.001). Three patients (6.1%) had neurological symptoms (headache or dizziness) and all were serum CryAg-positive. One patient with Cryp-tococcus gattii developed fluctuating serum CryAg titers after a 12-month antifungal treat-ment. No relapse occurred in the remaining 48 patients, irrespective of postoperative antifungal treatment. Conclusion: In patients with primary pulmonary cryptococcosis, serum CryAg detection rate is low, and VATS was an effective and safe diagnostic and therapeutic tool. Copyright 2022, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This study retrospectively investigated the treatment outcomes of video-assisted thoracoscopic surgery (VATS) for primary pulmonary cryptococcosis in 49 patients. The results showed that VATS was an effective and safe diagnostic and therapeutic tool for primary pulmonary cryptococcosis.