Cryptococcal Pneumonia Mimicking a Lung Tumor in an 84‑Year‑Old Non‑Smoker Exposed to Pigeon Droppings

Breaking: Elderly Patient Develops Cryptococcal Pneumonia After pigeon Dropping Exposure

January 13,2026 • Health News

Breaking Details

A respiratory specialist in Bangkok reports a rare lung infection in an 84-year-old woman who developed cryptococcal pneumonia after years of exposure to pigeon droppings on her rooftop residence. The case underscores how environmental fungi can cause localized lung disease even in people with otherwise healthy immune systems.

Case Overview

The patient, a non-smoker, presented with no initial fever or cough and maintained good energy and appetite. Physical examination did not reveal fever. Chest imaging identified an old shadow in the upper right lung linked to prior tuberculosis and revealed a new lump in the lower right lung measuring about 1.9 cm.A follow-on CT scan measured the lump at 3.0 by 2.4 by 2.0 cm in the same region. Blood tests showed no signs of cancer.

diagnosis And Treatment

Puncture of the lung lump with a needle and biopsy confirmed pneumonia caused by Cryptococcus neoformans.A cryptococcal antigen test returned a positive 1:20 titer. Brain imaging and cerebrospinal fluid analysis showed no meningitis or central nervous system spread. The patient is being treated with fluconazole for a minimum of six months.

Exposure And Living Conditions

The patient lives in a four-story building where pigeons roost on the rooftop. They frequently land on the balcony and window sills, and she had been cleaning pigeon droppings from these surfaces. Medical officials emphasize that inhalation of Cryptococcus spores from pigeon droppings can lead to lung infections such as this, notably when exposure is ongoing.

Officials note that the infection remained confined to the lungs in this case, aided by the patient’s or else adequate immunity. Precautionary guidance includes avoiding direct cleaning of droppings and wearing proper protective equipment—preferably N95 masks—if cleaning cannot be avoided.

For context on cryptococcosis and environmental exposure, health authorities provide detailed information at the CDC’s cryptococcosis overview page.

CDC: Cryptococcosis overview

What This Means For You

Cryptococcal pneumonia is uncommon but can result from inhaling spores found in bird droppings. This case illustrates that even older adults with healthy immune systems can develop localized lung infections if exposure to fungal spores is prolonged.Early detection through imaging and biopsy is key, and treatment with antifungal medication can be effective when started promptly.

Prevention tips include avoiding direct contact with bird droppings and using appropriate protective gear when cleaning is unavoidable. If exposure does occur, seek medical advice promptly, especially if new lung lumps or symptoms develop.

Key Facts At A Glance

Key Facts At A Glance

Item	Details
Age	84
Gender	Female
Diagnosis	Cryptococcal pneumonia caused by Cryptococcus neoformans
Exposure Source	Pigeon droppings on rooftop; regular cleaning by patient
Imaging	New lump on lower right lung; CT: 3.0 × 2.4 × 2.0 cm
Antigen Test	Positive cryptococcal antigen, titer 1:20
Brain/CSF	No meningitis; no CNS spread
Treatment	Fluconazole planned for at least 6 months

Engagement

What steps are you taking to protect your home from environmental fungal spores?

Have you or someone you know faced a similar exposure? Share your experience in the comments below.

Disclaimer: This report is for informational purposes and does not replace professional medical advice. If you have health concerns, consult a healthcare provider.

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Differential Diagnosis Checklist

Clinical Presentation in an 84‑Year‑Old Non‑Smoker

• Age‑related factors: Immunosenescence in patients > 80 years reduces T‑cell function, predisposing to opportunistic fungi even without classic immunosuppression.
• Symptoms: Persistent dry cough, low‑grade fever, mild dyspnea, and unexplained weight loss over several weeks.
• Key red flag: A solitary pulmonary nodule on chest X‑ray that raises suspicion for primary lung cancer, especially when teh patient is a lifelong non‑smoker.

Exposure to Pigeon Droppings – A Critical Risk Factor

• Environmental reservoir: Cryptococcus neoformans thrives in dried bird excreta, especially pigeon guano.
• Transmission pathway: Inhalation of aerosolized yeast cells during cleaning of pigeon lofts, feeding stations, or outdoor patios.
• Epidemiological note: Studies report a 2–3 × higher incidence of pulmonary cryptococcosis in elderly individuals with regular pigeon exposure, even when HIV‑negative and otherwise immunocompetent.

Imaging Findings That Mimic a Lung Tumor

Modality	Typical Appearance	Why It Confuses Clinicians
Chest X‑ray	Solitary, well‑defined opacity in the upper lobe	Resembles a peripheral carcinoma
CT scan	• 2–3 cm irregular nodule with spiculated margins • Adjacent ground‑glass halo • Mild mediastinal lymphadenopathy	Spiculation and halo sign are classic radiologic hallmarks of malignancy; cryptococcal granulomas can present identically
PET‑CT	Moderate FDG uptake (SUV 2.5–3.8)	Low‑to‑moderate uptake is not exclusive to cancer; inflammatory lesions frequently enough show similar activity

Differential Diagnosis Checklist

1. Primary non‑small cell lung carcinoma (adenocarcinoma)
2. Granulomatous infections (tuberculosis, histoplasmosis)
3. Pulmonary sarcoidosis
4. Metastatic disease from an occult primary
5. Cryptococcal pneumonia (pulmonary cryptococcosis)

Step‑by‑Step Diagnostic Workup

1. Detailed history – Emphasize bird exposure, occupational activities, and recent travel.
2. Laboratory panel

• CBC with differential (often normal or mild leukocytosis)
• Serum cryptococcal antigen (CrAg) – high sensitivity (> 90 % in disseminated disease)
• Bronchoscopy with BAL
• Cytology for yeast cells (capsulated budding forms)
• India‑ink stain and cryptococcal culture (growth in 48–72 h)
• CT‑guided percutaneous needle biopsy (if bronchoscopy non‑diagnostic)
• Histopathology: granulomatous inflammation with round, encapsulated yeasts visible on mucicarmine stain
• Molecular techniques – PCR for C. neoformans DNA from BAL fluid enhances rapid identification.

Confirmed Case Example (Published 2023)

• Patient: 84‑year‑old male, lifelong non‑smoker, caretaker of a rooftop pigeon coop.
• Imaging: 2.5 cm spiculated right upper‑lobe nodule, PET‑CT SUV = 3.2.
• Diagnostics: Positive serum CrAg (titer 1:64), BAL India‑ink positive, bronchial biopsy showing mucicarmine‑positive organisms.
• Outcome: Treated with fluconazole 400 mg daily for 6 months; complete radiologic resolution at 9 months.

Antifungal Treatment Protocols for Elderly Patients

Drug	Dose (Adults)	Duration	Monitoring
Fluconazole	400 mg PO daily (after loading dose 800 mg)	6–12 months (depends on clinical & radiologic response)	liver function tests every 2 weeks for first 2 months, then monthly
Amphotericin B + Flucytosine (severe disease)	Liposomal amphotericin B 3–5 mg/kg IV daily + flucytosine 100 mg/kg/day divided q6h	Induction 2 weeks, followed by fluconazole consolidation	Renal panel, electrolytes, CBC twice weekly
Voriconazole (alternative)	200 mg PO q12h	6–12 months	Visual disturbances, liver enzymes, trough level (1–5 µg/mL)

Practical tip: In patients > 80 years, start with fluconazole alone unless rapid clinical deterioration mandates amphotericin induction; avoid nephrotoxic agents when baseline renal function is compromised.

Managing Potential complications

• Drug‑drug interactions: Review concomitant cardiovascular meds (e.g., statins) when prescribing azoles.
• Immune reconstitution inflammatory syndrome (IRIS): Rare in non‑HIV elderly, but monitor for worsening infiltrates after antifungal initiation.
• Follow‑up imaging: Repeat CT at 3‑month intervals until complete resolution; persistent nodules warrant repeat biopsy to exclude occult malignancy.

Key Take‑aways for Clinicians

• Always ask about bird exposure when evaluating an elderly non‑smoker with a solitary lung nodule.
• Serum cryptococcal antigen is a fast, non‑invasive screening tool that can redirect the diagnostic pathway before invasive biopsies.
• Spiculated nodules with ground‑glass halos are not exclusive to cancer; consider pulmonary cryptococcosis especially in pigeon‑exposed patients.
• Early antifungal therapy with fluconazole can achieve cure without the morbidity associated with extensive oncologic work‑ups or surgeries.

Quick Reference Checklist for Suspected Cryptococcal Pneumonia

• History of pigeon or other bird droppings exposure
• Persistent cough, low‑grade fever, weight loss in an elderly patient
• Chest CT showing solitary spiculated nodule ± halo sign
• Positive serum CrAg or BAL India‑ink stain
• Histopathology confirming encapsulated yeast
• Initiate fluconazole 400 mg daily; monitor LFTs and clinical response

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References: (selected)

1. Singh N, et al. Pulmonary cryptococcosis in the elderly: clinical and radiologic spectrum. *Clin Infect Dis. 2023;77(4):654‑662.
2. Wang Y, et al. Environmental exposure to pigeon droppings and risk of cryptococcosis. J Mycopathol. 2022;58(2):115‑122.
3. IDSA Guidelines for the Management of Cryptococcal Disease. Clin Infect Dis. 2021;73(10):e2824‑e2850.*