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Disseminated Cryptococcus neoformans presenting with an isolated pleural effusion in a patient receiving temozolomide and long-term steroids
  1. Brooke Fraser1,2,
  2. Maha Munawar1,
  3. Sheliza Halani1,2 and
  4. Natasha Sabur1,3
  1. 1Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
  3. 3Respirology, St Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Sheliza Halani; sheliza.halani{at}


Cryptococcus neoformans is a ubiquitous environmental organism found worldwide. Infection with this organism occurs predominantly in immunocompromised hosts, including persons living with HIV or those with impaired cellular immunity. Cryptococcal pleural effusions have been described in cases with extensive pulmonary involvement. Here we present the case of a woman receiving temozolomide and steroids for glioblastoma multiforme, who developed cough and dyspnoea and was found to have an uncomplicated pleural effusion. Pleural fluid culture grew Cryptococcus neoformans with negative culture on bronchoalveolar lavage. High serum cryptococcal antigen titre of 1:64 prompted lumbar puncture which demonstrated positive cerebrospinal fluid for Cryptococcus neoformans. She was treated with liposomal amphotericin B and flucytosine, followed by consolidation and maintenance therapy with fluconazole. Pleural involvement in the absence of pulmonary involvement has rarely been reported. We review pulmonary and radiographic manifestations of cryptococcal infection, when to assess for disseminated infection, and management principles.

  • Cryptococcus
  • Meningitis
  • Pleural infection
  • Infections

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  • BF and MM are joint first authors.

  • SH and NS are joint senior authors.

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BF, MM, NS, SH. The following authors gave final approval of the manuscript: BF, MM, NS, SH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.