Immune reconstitution inflammatory syndrome, with pulmonary and neurological cryptococcosis, in an HIV-negative patient

The differential diagnoses include other diseases affecting the trachea, not only those presenting localized involvement— such as primary tracheal neoplasms, injuries of traumatic origin , and some infectious diseases—but also those presenting diffuse involvement—amyloidosis, tracheobronchopathia osteochondroplastica, relapsing polychondritis, laryngotracheo-bronchial papillomatosis, tracheobronchomegaly, neurofibroma-tosis, Wegener's granulomatosis, lymphoma, and paracocci-dioidomycosis (5,7–12). Imaging studies have become increasingly important in the evaluation of chest diseases, as recently noted in the radiology literature of Brazil (13–19). In the study of the trachea, imaging studies comprise X-rays and, primarily, CT of the chest, which can show irregular, circumferential narrowing of the lumen, with or without mediastinitis. In fibrotic disease, the lumen is smoother and the wall is not thickened. Lymphadenopathy is generally associated with active tuberculosis (4,6). Bronchoscopy can reveal inflamed mucosa, submucosal granuloma or polyp, ulceration, hypertrophy, or cicatricial steno-sis; histologically, tracheobronchial tuberculosis can be identified the presence of giant cell granuloma and caseous necro-sis (1). Although the gold standard for the diagnosis of tracheo-bronchial tuberculosis is the finding of granulomas in the tra-cheal/bronchial mucosa, a diagnosis based on imaging findings and sputum positivity is accepted and enables immediate treatment (2). Making a diagnosis of tracheobronchial tuberculosis requires suspicion, and it is necessary to correlate the clinical manifestations with the radiological findings. Early diagnosis and treatment can avert the complications of the disease. A, et al. Primary tracheal non-Hodgkin lymphoma: case report with an emphasis on computed tomog-raphy findings. A 26-year-old male presented with complaints of cough and fever for a few days. He reported having followed a weight loss program for the last four months, having lost 20 kg. He reported no comorbidities. Chest X-ray showed pulmonary consolidation in the left lung. A complete blood count showed leukocytosis and a lymphocyte count at the lower limit of normality. Subsequent X-rays, during antibiotic therapy, showed an increase in the consolidation. Computed tomography of the chest showed left lung consolidation with air bronchogram and a partially rounded hilar opacity, both containing areas of hypointense signals (Figure 1A), raising the hypothesis of an infectious or neoplastic process. Because he developed mental confusion, seizures, and postural instability, the patient was submitted to magnetic resonance imaging (MRI) of the brain, which showed multiple intraparenchymal cystic lesions (Figure 1B), with no enhancement and minimal edema at the borders. Pathological examination of a biopsy sample obtained from the pulmonary consolidation revealed fungal infection with characteristics of deep cryptococcal mycosis. Staining with mucicar-mine …