Pulmonary cryptococcosis presenting with a large cavity

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 Clostridium 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.