Korean J Pediatr 2010;53(11):971-974 • DOI: 10.3345/kjp.2010.53.11.971 973 A B Fig. 3. (A) Follow-up chest radiograph shows decreased opacity in the lower lobe of the left lung (arrow). (B) Follow-up chest CT image reveals resolution of lesions in the lower lobe of the left lung. however, others suggest that exposure to this fungus is common among children, especially those living in an urban area6, 7). This suggests that cryptococcal infection may be common in children, but the infection is subclinical or not recognized4). the most specific staining forCryptococcosis 1). Fluconazole therapy is recommended in immunocompetent patients with asymptomatic cryptococcosis confined to the lungs13). The patient received oral fluconazole therapy for 8 weeks, and the The characteristics of pulmonary cryptococcosis in immuno- follow-up chest CT showed resolution of the lesions. A substantial competent subjects have not yet been understood well. An proportion of patients with cryptococcosis are apparently interesting aspect of pulmonary cryptococcosis is the potential for asymptomatic, especially in immunocompetent subjects. For developing asymptomatic disease especially in immunocompetent this reason, pulmonary cryptococcosis should be considered as subjects3, 8). Healthy individuals might also present with symptoms such as cough, fever, night sweating4). Since mild and non-specific symptoms appear and lesions are localized to the lungs with good clinical outcomes, it is inferred that host immune status may affect clinical manifestations9). Lesions due to C. neoformans vary in terms of inflammation depending on the host and the affected organ. Thus lesions seen in immunocompetent hosts and in the lungs tend to be more granulomatous than lesions seen in immunocompromised patients or in the brain10). A high index of clinical suspicion is required for the diagnosis of pulmonary cryptococcosis in immunocompetent children without clinical symptoms. The most common radiologic findings of pulmonary cryptoco- ccosis are solitary or multiple nodules11). The patient had multiple nodules in the parenchyma and subpleural space of the left lower lobe. Misdiagnosis to pulmonary tuberculosis or sarcoidosis is possible because tuberculosis infection is relatively common in Korea12). A definitive diagnosis of pulmonary cryptococcosis can be established by histological identification of the fungus in lung biopsy specimens. Generally, Hematoxylin-eosin staining of the specimen shows granulomatous lesions, which should be distinguished from tuberculosis and sarcoidosis11). In general, as well as in this case, yeast-like cells are seen by Gomori methenamine silver staining and the characteristic rose-red capsule of C. neoformans is identified by Mayer’s mucicarmine staining, which is a differential diagnosis for asymptomatic pulmonary nodules, especially in cases showing well-delineated nodules. References 1) Severo CB, Xavier MO, Gazzoni AF, Severo LC. Cryptococcosis in children. Paediatr Respir Rev 2009;10:166-71. 2) Choe YH, Moon H, Park SJ, Kim SR, Han HJ, Lee KS, et al. Pulmonary cryptococcosis in asymptomatic immunocompetent hosts. Scand J Infect Dis 2009;41:602-7. 3) Kishi K, Homma S, Kurosaki A, Kohno T, Motoi N, Yoshimura K. Clinical features and high-resolution CT findings of pulmonary cryptococcosis in non-AIDS patients. Respir Med 2006;100:807-12. 4) Sweeney DA, Caserta MT, Korones DN, Casadevall A, Goldman DL. A ten-year-old boy with a pulmonary nodule secondary to Cryptococcus neoformans: case report and review of the literature. Pediatr Infect Dis J 2003;22:1089-93. 5) Flood RG, Aronoff SC. Cryptococcus noeformans. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. 18th ed. Nelson textbook of pediatrics. Philadelphia: Saunders Co, 2007;1310-12. 6) Abadi J, Pirofski L. Antibodies reactive with the cryptococcal capsular polysaccharide glucuronoxylomannan are present in sera from children with and without human immunodeficiency virus infection. J Infect Dis 1999;180:915-9. 7) Goldman DL, Khine H, Abadi J, Lindenberg DJ, Pirofski LA, Niang R, et al. Serologic evidence for Cryptococcus neoformans infection in early childhood. Pediatrics 2001;107:e66. 8) Nadrous HF, Antonios VS, Terrell CL, Ryu JH. Pulmonary crypto- coccosis in nonimmunocompromised patients. Chest 2003;124:2143-7.