• Vol. 34 No. 5, 394–396
  • 15 June 2005

Cavitating Cryptococcal Pneumonia in the Immunocompetent Host



Introduction: Isolated cryptococcal pneumonia in the immunocompetent host is a rare infection. Indications for treatment and its duration are currently not defined. Clinical Picture: Three patients presented with cavitating cryptococcal pneumonia. Treatment: They were treated with oral fluconazole. Outcome: Improvement was evident clinically, radiologically and serologically. Fluconazole was continued until serum cryptococcal antigen (SCA) levels were negative in our patients as they had manifestations such as haemoptysis, cavitating or multi-lobar pneumonia and relatively high antigen levels, suggesting potentially serious disease. Conclusions: Fluconazole is effective and safe for the treatment of cryptococcal pneumonia in the immunocompetent host. Although the role of monitoring SCA levels in the immunocompetent host is currently unclear, it may be an indication of infective burden and the benefits of longer treatment seem to outweigh the risks.

Three immunocompetent male patients with cryptococcal pneumonia presented to our hospital between June 2000 and November 2001. They had varied presentations, as shown in Table 1. All 3 patients were previously well, without any underlying diabetes mellitus, renal or hepatic diseases, and none was on any immunosuppressants. None of them appeared Cushingnoid. Their blood counts, including differential counts, were normal. Two patients had normal CD4 and CD8 counts. They all tested negative for human immunodeficiency virus (HIV). Central nervous system (CNS) involvement was excluded by cerebrospinal fluid (CSF) analysis, which was negative for cryptococcal antigen and fungal culture. Two patients had known long-term exposure to pigeons around air-conditioning vents outside their workplace and areas of residence. The third patient had no such exposure.

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