972 S. Bauer • Isolated pulmonary cryptococcosis A B Fig. 1. (A) Chest radiograph shows patch opacity in the lower lobe of the left lung (arrow). (B) Chest computerized tomography (CT) demonstrates multiple nodules in the lower lobe of the left lung (arrow). A B Fig. 2. A) Biopsy specimen shows multiple variable-sized (diameter range, 2-20 µm), round to oval yeasts with narrow-necked budding (arrow); (Gomori methenamine silver staining, ×400). B) Multiple round to oval yeasts with budding show a faint rim of mucicarmine staining, indicating the characteristic rose-red capsule of Cryptococcus neoformans (arrow; Mayer’s mucicarmine staining, ×1,000). and nontuberculous Mycobacterium . The specimen exhibited nervous system, he underwent brain magnetic resonance imaging, multiple non-necrotizing granulomatous lesions by hematoxylin- which showed no abnormal findings. eosin staining and round, black yeast-like bodies by Gomori Two weeks after administration of oral fluconazole (300 mg/ methenamine silver staining (Fig. 2A). Since the bodies were day), follow-up chest x-ray showed decreased size of patchy opacity suspicious of fungus, PAS staining and Mayer’s mucicarmine in left lower lobe (Fig. 3A), eight weeks after medication follow-up staining (Fig. 2B) were performed, which identified the rose-red chest CT revealed the disappearance of the lung nodules (Fig. 3B). capsules ofC. neoformans . Routine laboratory findings including: white blood cell counts 12,500/μL (neutrophil 75%, absolute neutrophil count 7,575/μL), Discussion hemoglobin 12.9 g/dL, aspartate aminotransferase 14 IU/L, alanine The patient presented with isolated pulmonary cryptococcosis aminotransferase 9 IU/L, showed no specific findings, c-reactive without immunological abnormalities. Although cryptococcosis protein 15.2 mg/L showed mild elevation. usually occurs in immunocompromised subjects, it has been No abnormal findings were noticed in humoral antibody levels reported that pulmonary cryptococcosis is also discovered in (IgG 1,430 mg/dL, IgA 282 mg/dL, IgM 176 mg/dL, and IgE 2.7 the immunocompetent host2, 4). Cryptococcosis is thought to be IU/mL), cellular immunological parameters (lymphocytes 1657/ acquired by inhalation of fungus contained in the excretion of μL, CD4+ T cell 410/μL, and CD8+ T cell 340/μL), C3 (104 mg/ birds such as pigeons, canaries and cockatoos into the respiratory dL), C4 (19.6 mg/dL) and CH50 (40.6 mg/dL). The patient was system. It may also be found on fruits and vegetables, or carried negative for the human immunodeficiency virus antibody test. Since cryptococcosis is reported to frequently occur in the central by cockroaches5). Several reports indicated that pulmonary cryptococcosis among children is particularly uncommon1, 4),