Abstract: Objective To raise the awareness of pulmonary cryptococcosis (PC) among tuberculosis specia-lists. Methods From January 2014 to May 2017, there were 26 cases of PC misdiagnosed and referred to Wuhan Pulmonary Hospital (Wuhan Institute for Tuberculosis Control). The clinical features,laboratory examinations,chest CT images and treatment of these 26 cases PC were retrospectively analyzed. Results The patients consisted of 18 (69.2%) males and 8 (30.8%) females,with a mean age of (49.9?3.9) years (range,22 to 77). Eleven (42.3%) cases presented with CT image abnormality, but with no clinical symptoms and 15 (57.7%) cases presented with a mild cough, chest tightness or chest pain. White blood cell counts were normal except for 2 cases. Twenty cases were confirmed as PC by pathology,and 6 cases were confirmed as PC through cryptococcal capsular antigen test positive, and the fact that they were cured with antifungal therapy. A total of 16 cases were tested with serum cryptococcal capsular antigen, with a positive rate of 100.0%. Chest CT showed that unilateral lung involvement in 18 cases, and bilateral lung involvement in 8 cases. Only 2 cases were with both upper and lower lung involvement. The common CT imaging features of the PC included peri-pheral pulmonary distribution was 88.5% (23/26), and the existence of pulmonary nodule was 88.5% (23/26), including 69.2% (18/26) with multiple nodule,halo sign 80.8% (21/26) and pleural thickening 84.6% (22/26). Rare imaging signs were solitary nodules 19.2% (5/26), masses 15.4% (4/26), and consolidation 15.4% (4/26). No lymph node enlargement and pleural effusion were found in all cases. All patients were clinically cured with fluconazole. Conclusion The clinical symptoms of PC were mild and more common in middle-aged and older males. The imaging of PC was mostly in unilateral and single part involvement, with more peripheral pulmonary distribution and the imaging features were the multiple nodules with the halo sign and the pleural thickening. High specificity of the diagnosis of PC was found by a cryptococcal capsular antigen test. After treatment with antifungal therapy, the prognosis of PC is good.

Key words: Cryptococcosis, Tuberculosis, pulmonary, Tomography, X-Ray computed, Laboratory techniques and procedures, Diagnosis, differential, Disease attributes