title: A case of miliary pulmonary cryptococcosis and review of literature.
abstract: We describe a case of cryptococcal fungemia in a 62-year-old male renal transplant patient. The diagnosis was established by isolation of Cryptococcus neoformans using the Isolator(®) blood culture lysis-centrifugation system. Testing for cryptococcal antigens was negative in the serum and cerebrospinal fluid. Transbronchial lung biopsies and bronchoalveolar lavage were negative. Antifungal therapy with fluconazole was started, resulting in fever remission, and a sustained clinical response was achieved. The literature on miliary pulmonary cryptococcosis is reviewed, and three similar cases were previously reported with disseminated cryptococcosis that resembled miliary tuberculosis on imaging. These emphasize the importance of eliminating causes other than tuberculosis in patients presenting with miliary pulmonary disease, even in countries with a high prevalence of tuberculosis.
authors.affiliation: Laboratório de Micologia, Hospital Santa Rita, Irmandade Santa Casa de Misericórdia Porto Alegre (ISCMPA), Annes Dias 285, Porto Alegre, RS, 90020-090, Brazil.
authors.forename: Cecília Bittencourt
authors.initials: CB
authors.lastname: Severo
authors.forename: Rosana Mussoin
authors.initials: RM
authors.lastname: Bruno
authors.forename: Flávio de Mattos
authors.initials: Fde M
authors.lastname: Oliveira
authors.forename: Paulo Zimmermann
authors.initials: PZ
authors.lastname: Teixeira
authors.forename: Bruno
authors.initials: B
authors.lastname: Hochhegger
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Severo
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents