Diffuse cryptococcal pneumonia in multicentric Castleman's disease with elevated serum IgG4

A woman in her 60s with suspected multicentric Castleman's disease, who was receiving treatment with oral prednisolone, presented to our hospital with mild cough and malaise. Chest CT showed diffuse infiltrative and granular shadows, indicating exacerbation of lung lesions caused by steroid-resistant multicentric Castleman's disease. A video-assisted thoracoscopic lung and mediastinal lymph node biopsy was performed. The biopsy revealed mediastinal lymph node tissue consistent with multicentric Castleman's disease, as well as presence of Cryptococcus neoformans in the alveolar space. C. neoformans infection in immunocompromised individuals may present with diffuse lung lesions and should be noted as a mimicker of acute exacerbation of Castleman's disease.

Automated summary

A woman in her 60s with suspected multicentric Castleman's disease developed exacerbation of lung lesions caused by steroid-resistant disease and was found to have Cryptococcus neoformans infection in the alveolar space. This highlights the importance of considering C. neoformans as a possible mimicker of acute exacerbation of Castleman's disease in immunocompromised individuals.