Pulmonary and Meningeal Cryptococcosis in an Immunocompetent Patient: A Case Report

Cryptococcosis is a systemic mycosis caused by Cryptococcus neoformans and Cryptococcus gattii and has worldwide distribution. Its occurrence in immunocompetent individuals is rare, which makes diagnosis challenging due to low suspicion and the diversity of clinical manifestations, and implies delays in treatment and worsening prognosis. This is a descriptive case report study conducted at a teaching hospital in the city of Juiz de Fora, Minas Gerais, aiming to describe an atypical case of cryptococcosis in an immunocompetent patient. The study describes the clinical course, laboratory and imaging findings, and treatment of an immunocompetent patient diagnosed with pulmonary and meningeal cryptococcosis who was hospitalized during April and May 2025 in this service. Information was obtained by reviewing the medical records. The study was conducted in accordance with ethical principles for research involving human beings. A 58-year-old male presented with pleuritic pain in the right hemithorax, night sweats, daily fever, and headache for 25 days. Chest CT revealed an expansive lesion involving the entire upper lobe of the right lung. Transthoracic biopsy of the lesion showed yeast-like structures suggestive of Cryptococcus sp. CSF examination revealed encapsulated yeast-like structures on India ink staining and growth of Cryptococcus sp. in culture. Treatment was carried out with liposomal amphotericin B and flucytosine at standard doses for 28 days, followed by fluconazole 800 mg/day. The patient evolved with worsening ventilatory pattern and dyspnea, as well as radiologic deterioration, and decortication and resection of the right upper lobe were indicated. Tissue and pleural fluid samples were collected for microbiological tests. India ink staining revealed encapsulated yeast-like structures, but no fungal growth was observed in culture. In the postoperative period, continuous suction drainage was used to aid lung re-expansion, and the patient developed nosocomial pneumonia on the 5th postoperative day. Late diagnosis of the disease may impact individual morbidity and mortality. Prospective studies are needed to observe the evolution of the disease in immunocompetent patients in order to support the development of therapeutic and diagnostic guidelines tailored to this population.