Today’s morning report case focused on a patient with poorly controlled diabetes who presented with non-productive cough for several months and was found to have a large RUL heterogeneous consolidation secondary to pulmonary Cryptococcosis. Take a look at some of the important learning points below:

• Invasive Cryptococcal infections occur primarily due to Cryptococcus neoformans (more common) or Cryptococcus gattii.
• The fungus is often inhaled and causes an initial pulmonary pneumonitis/infection
• The vast majority of infected symptomatic patients are immunocompromised, however invasive disease can also occur in immunocompetent individuals.
• Symptoms of Cryptococcal pneumonia are quite variable and can range from fever/cough/dyspnea to acute respiratory failure
• The CNS is the most common site of disseminated cryptococcosis: look for headache, fever, elevated protein, very high opening pressures on LP and a positive CSF Cryptococcal Antigen, which has a very high sensitivity and specificity
• Treatment of mild-moderate pulmonary disease is usually fluconazole, whereas disseminated disease requires Ampho B + Flucytosine