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Lung nodule - could it be years old fungal infection?
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Lung nodule - could it be years old fungal infection?

History:
Asthma, taking albuterol & have been prescribed Advair in the past.  Recurrent bronchitis.

2001 - Hemoptysis diagnosed through bronchoscope as cryptococcus infection, treated with fluconazole(sp) for 6 months.  2 years worth of follow xrays showed clear chest.

Oct 2008 - underwent cardiac stress test & ct scan for chest tightness, heart OK but they did find a small 5-6mm nodule in the mid anterior left lung.  Scheduled for 6 month follow up ct.

Nov 2008 - Fighting with bronchitis.  

Question:  I understand a 5-6mm nodule might not show up on xray, so perhaps this nodule is just a scar from the previous fungal infection.  But can cryptococcus fungus lay dormant in a person's lungs for 7 years and reactivate?  I also understood that infectious nodules usually disappear after the infection is gone, so should I assume that this is not a permanent scar from the fungal infection?  Also, I quit taking the Advair because of what I've read, but would it be safe to take Advair now, or could it possibly be counteraffective considering my current diagnosis?

Thank you so much for your help.  I have 5 more months of waiting - -
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First, what you describe as “recurrent bronchitis, may actually be a flare-up of asthma.

By standard criteria, a 5-6 mm nodule is a very small nodule and, as you suggest might not be apparent on a chest X-ray.  Or, with serial X-rays, might be apparent some of the time and not visible other times.  Nevertheless, the first step should be to retrieve all your previous chest X-rays (not just the reports, but the X-rays too) and have them compared with the most recent film that shows the nodule.  If you do not smoke cigarettes and are 40-45 years old or less, the recommendation to repeat the CT in six months is sound.

Cryptococcal infection is uncommon.  The majority of infections occurs in persons who have one of a number of immunodeficiency states but 20% of infections occur in persons with no underlying disease and these infections are often secondary to exposure to infected pigeon droppings.  That you have had no recurrence of this or any other unusual infection in 7 years suggests that you fall in that 20%.   Dormancy, with reactivation is almost never a problem.

And, yes, the nodule could be a scar, either from the Cryptococcus or any of a variety of other fungal and/or occupational exposures.  It is very common for such scar/nodules to not disappear after an acute infection; to remain in the lung, unchanged in size, indefinitely.  Stability of such a nodule over a two year period is considered strong evidence of its being benign.

Yes, it would be safe to take Advair, for either bronchitis or asthma.
2 Comments
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Thank you for your time and thoroughness in your answer.  I am a smoker @ 25 pack years and am 46.  They tested me for HIV - negative but I do have ANA positive.  I was exposed to old bird droppings when first moving into my home.  Plus I had an MRSA abscess in armpit that took 3 months to clear up last year, but that I believe is unrelated.  I really appreciate your answer and will attempt to obtain the old x-rays and have them sent to my current doctor who found the nodule.  You have helped relieve some anxiety for me and I am grateful.
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