Variant Forms of Pulmonary Cryptococcosis

Cryptococcus neoformans was cultured from the sputum bronchial washings, or lung of 32 patients, 25 of whom were white men. Eight patients had invasive pulmonary disease; this was demonstrated by lung resection or biopsy in six. Pulmonary invasion was suspected in three other patients, one of whom had hilar adenopathy, and could not be excluded in three additional patients with terminal malignancy. The remaining 18 patients were thought to have saprophytic colonization. In 12 of the 18, C. neoformans was transient. In one it was recurrent, and in five it was present in multiple sputum specimens over periods ranging from 10 months to 3½ years. Preexisting pulmonary disease was present in 15 of the 18 patients. Serologic testing did not differentiate patients with invasive disease from those with saprophytic colonization. In patients without clinical or radiologic evidence of invasion, treatment with amphotericin B is best withheld.