CASE REPORT article
Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Cryptococcus neoformans Infection Presenting as a Mediastinal Mass in an Immunocompetent Child with Parrot Exposure: A Case Report and Literature Review
Guangxian Yang 1
Siping He 2
Jinghua Wang 1
Sijing Yu 3
Shuju Zhang 4
Wenwen Fan 5
1. Cardiothoracic surgery, Hunan Children's Hospital, Changsha, China
2. Radiology department, Hunan Children's Hospital, Changsha, China
3. Infection department, Hunan Children's Hospital, Changsha, China
4. Institute of Pediatrics, Hunan Children's Hospital, Changsha, China
5. Hematology Ward 2; Clinical Nursing Teaching and Research Section,, The Second Xiangya Hospital of Central South University, Changsha, China
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Abstract
Cryptococcus neoformans typically causes pulmonary or central nervous system (CNS) infections, but mediastinal mass as its primary manifestation is rare—especially in immunocompetent children with pet parrot exposure. This study reports a 7-year-old girl who presented with recurrent fever and a mediastinal mass secondary to Cryptococcus neoformans infection, with a 5-month history of daily contact with parrot feces. Conventional diagnostic tests (e.g., fungal culture, serology) were negative, and the diagnosis was confirmed by targeted metagenomic next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF). The patient received a three-phase antifungal regimen: induction with amphotericin B + flucytosine, consolidation with fluconazole, and maintenance with low-dose fluconazole. After one year of treatment, the mediastinal mass nearly resolved, and no recurrence was observed. A literature review, supplemented with specific cases of parrot-associated Cryptococcus neoformans infection, highlights that parrot exposure is an underrecognized risk factor for pediatric cryptococcosis, and tNGS significantly improves diagnostic efficiency for atypical extrapulmonary manifestations. This case emphasizes the importance of inquiring about pet bird exposure in children with unexplained mediastinal masses and fever, and supports the use of tNGS for early, non-invasive diagnosis.
Summary
Keywords
Cryptococcus neoformans, Mediastinal mass, Parrotexposure, pediatric infection, Targeted metagenomic next-generation sequencing
Received
22 December 2025
Accepted
04 February 2026
Copyright
© 2026 Yang, He, Wang, Yu, Zhang and Fan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wenwen Fan
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