title: Pulmonary cryptococcosis presenting with a large cavity.
abstract: A 78-year-old woman who was receiving corticosteroids for rheumatoid arthritis was admitted to our hospital to have her fever, hemoptysis, diarrhea, and chest x-ray abnormalities, which were unresponsive to antibiotics, investigated. A chest computed tomography scan revealed infiltrative shadows and a large cavity in the right lower lobe. Laboratory tests revealed a white blood cell count of 13,100/μL, a serum C-reactive protein level of 8.75 mg/dL, a serum albumin level of 1.4 g/dL, and positivity for Cryptococcus antigen. Grocott staining of a transbronchial lung biopsy specimen detected black-brown fungi. Also, a stool sample was positive for C lostridium difficile toxin, leading to a diagnosis of pulmonary cryptococcosis and pseudomembranous colitis. The patient was given 200 mg/day intravenous fosfluconazole and 1500 mg/day oral metronidazole, and her condition improved. Immunocompromised hosts with pulmonary cryptococcosis demonstrate a wide variety of radiographic abnormalities, including nodules, cavitation, and infiltration.
authors.affiliation: Department of Respiratory Medicine, Shizuoka General Hospital Shizuoka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Respiratory Medicine, Shizuoka General Hospital Shizuoka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shirai
authors.affiliation: Department of Respiratory Medicine, Shizuoka General Hospital Shizuoka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Asada
authors.affiliation: Department of Respiratory Medicine, Shizuoka General Hospital Shizuoka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujii
authors.affiliation: Department of Pathology, Shizuoka General Hospital Shizuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Second Department of Internal Medicine, Hamamatsu University School of Medicine Hamamatsu, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
keywords: Cavitation; Cryptococcus; immunocompromised host