The primary pulmonary lymph node complex of crytptococcosis.

A cryptococcal primary pulmonary lymph node complex has been demonstrated at autopsy or after thoracotomy in 1% of the cases of cryptococcosis. Stepwise microscopic examination of hilar lymph nodes should reveal a more frequent incidence of this rare but now well-documented complex. Nine examples of the cryptococcal complex are extant, including three herewith reported from the files of the Armed Forces Institute of Pathology. Four of these complexes developed in apparently normal persons and five in those hypersusceptible to infection because of neutropenia, diabetes, renal insufficiency, or corticosteroid therapy. The complexes in the normal persons were circumscribed granulomas and represented first-infection cryptococcosis similar to first-infection tuberculosis. There was a chronic course and a good prognosis with surgical resection. The complexes in the compromised hosts were predominantly acute diffuse pneumonias and large diffuse lesions of the lymph nodes, and were interpreted as first-infection cryptococcosis with massive spread facilitated by the compromised state. All these compromised patients died within a few weeks.