Sripavatakul and Foocharoen Journal of Medical Case Reports 2011, 5:309 http://www.jmedicalcasereports.com/content/5/1/309 Page 3 of 6 Figure 3 Chest radiograph showing extensive interstitial infiltration compared to previous chest radiograph. minute) and a body temperature of 38.2°C. A lung examination revealed decreased breath sounds and vocal resonance of his right lung with a midline trachea posi- tion. The oxygen saturation of the room air at admis- sion was 92%. A complete blood count indicated a hemoglobin level of 14.2 g/dL, white blood cell count of 8,800 cells/mm3, and a platelet count of 247,000 cells/mm3. A chest radiograph revealed pneumothorax of his right lung (Figure 5). Cloudy yellow-colored fluid was found after a chest tube was inserted. The exudative profile of the pleural fluid included red blood cell count 890 cells/mm3 and white blood cell count 1,890 cells/mm3 (polymorpho- nuclear cells 64%, eosinophils 30% and lymphocytes 6%). Indian ink, Gram stain and acid-fast stain of the pleural fluid and sputum were negative; however, the pleural fluid was positive for cryptococcal antigen. The respec- tive culture of the pleural fluid and serum was positive for Cryptococcus neoformans, while the cerebrospinal fluid was negative. Due to desaturation and large air leakage, oxygen sup- plementation and drainage of his chest were performed Figure 4 HRCT chest scan reveals thickening of interlobular septa with sub-pleural emphysema and tubular bronchiectasis of right lower lung.