Case report DOI: 10.3345/kjp.2010.53.11.971 Korean J Pediatr 2010;53(11):971-974 Isolated pulmonary cryptococcosis in an immuno- competent boy Siegfried Bauer, M.D.1, Ji Eun Kim, M.D.1, Kyong Suk La, M.D.1, Young Yoo, M.D.1, Kee Hyoung Lee, M.D.1, Sang Hee Park, M.D.1, Ji Tae Choung, M.D.1, and Chul Whan Kim, M.D.2 Departments of Pediatrics1, Pathology2, College of Medicine, Korea University, Seoul, Korea Received: 4 June 2010, Reviced: 14 July 2010 Accepted: 4 August 2010 Corresponding author: Young Yoo, M.D. Department of Pediatrics, Korea University Anam Hospital, 126-1, 5-ga, Anam-dong, Sungbuk-gu, Seoul 136-705, Korea Tel: +82.2-920-5090, Fax: +82.2-922-7476 E-mail: yoolina@korea.ac.kr Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared. Key words: Cryptococcosis, Multiple pulmonary nodules, Child Copyright © 2010 by The Korean Pediatric Society This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Pulmonary crytococcosis that is caused by the inhalation of Cryptococcus neoformans (C. neoformans ) is uncommonly recognized in childhood1). Because it has commonly occurred in immunocompromised subjects, little is known about pulmonary cryptococcosis in immunocompetent subjects, especially in those with no clinical symptoms2, 3). We report herein a 16-year-old boy who had asymptomatic isolated pulmonary cryptococcosis confirmed by needle aspiration biopsy. Case report A 16-year-old boy presented at our clinic with the presence of round opacity in the left lower lobe on chest x-rays that were taken for routine preoperative workup due to ankle fracture. He had no significant past and family histories. He had no respiratory 971 symptoms such as cough, sputum or dyspnea but has a history of close contact with pigeons. The boy frequently used to visit a village with traditional houses, where many pigeons lived and kept some birds at home, too. On physical examination, he appeared healthy. Pulmonary auscultation and percussion revealed no abnormal findings. A simple chest x-ray (Fig. 1A) showed round opacity on left lower lobe. Chest computerized tomography (CT) revealed round and well defined nodules in the left lower lobe, multiple subpleural and parenchymal nodules in left upper lobe and enlarged lymph nodes in the left hilar area (Fig. 1B). Because radiographs of patients with pulmonary cryptococcosis are non-specific and can easily be confused with pulmonary tuberculosis, we performed AFB staining and AFB culture from sputum and got a negative result. Under local anesthesia, fluoroscope guided fine needle aspiration was conducted and a lung specimen received from left lower lobe. PCR from tissue specimen was negative for tuberculous