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Cryptococcal cavitary pneumonia in an immunocompetent patient.

Article Excerpt
Cryptococcus neoformans most commonly infects persons with an underlying T-cell immunodeficiency. It has been nicknamed the "sugarcoated killer" because it can cause a devastating disseminated illness in immunosuppressed patients. C neoformans rarely causes primary infection in an immunocompetent patient. We present a case of pulmonary cryptococcosis that occurred in an otherwise healthy man.

The case

A 26-year-old emergency medical technician presented to a community hospital emergency department with a cough of 6 weeks' duration and pleuritic chest pain. The cough was initially dry but became productive of yellow blood-tinged sputum 3 days before presentation. He had completed a 10-day course of amoxicillin therapy without clinical improvement.

The patient had had a cholecystectomy 1 year earlier and had no other medical history. He was not taking any medications and was allergic to sulfonamides. He was a lifelong nonsmoker, denied any history of drug or alcohol use, and had no known risk factors for HIV infection. The results of annual tuberculin skin testing had never been reactive, and he had no known exposure to infectious tuberculosis. His family history was noncontributory. Physical examination revealed a well-nourished, nontoxic-appearing man with normal vital signs. Pulmonary, cardiac, and abdominal examination findings were normal, and there were no focal neurological deficits. The patient's complete blood cell count and the results of a basic metabolic panel and liver function tests were normal on admission.

[FIGURE 1 OMITTED]

A chest radiograph revealed multiple cavitary lesions in the right upper lobe (Figure 1). A subsequent CT scan of the chest revealed multiple patchy areas of consolidation with cavitation most notable in the right lung (Figure 2A).

The patient was admitted to the general medicine floor with airborne precautions. Initial antibiotic therapy was withheld in the hopes of identifying a specific pathogen. The results of tuberculin skin testing and tests for HIV,...

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