Abstract Introduction Cryptococcus Neoformans is an opportunistic encapsulated fungus that causes cryptococcosis, an infection mostly observed in immunocompromised individuals but sometimes can also occur in immunocompetent hosts. The organism is typically acquired through inhalation of fungal spores from environmental sources such as soil or bird droppings, resulting in a primary lung infection. Lung involvement can range from asymptomatic disease with incidental imagining findings, to widespread disseminated interstitial infection. Imaging findings are variable and include solitary lung mass, multiple pulmonary nodules with or without cavitation, consolidation, lymphadenopathy and/or pleural effusions. Pulmonary Cryptococcosis presenting as an isolated pleural effusion is uncommon. We describe a case of cryptococcal infection manifesting as a large hemorrhagic pleural effusion in a patient newly diagnosed with alcoholic cirrhosis. Case Description A 51-year-old male with alcohol use disorder presented with a one-month history of progressive dyspnea associated with increasing abdominal girth, jaundice and dark urine. The patient was subsequently diagnosed with alcoholic cirrhosis based on laboratory and imaging findings. Chest imaging revealed a large left pleural effusion causing complete atelectasis of the left lung (Fig 1). A chest tube was placed, and pleural fluid studies were sent, which demonstrated a bloody lymphocytic-predominant exudative pattern. Cytology was negative for malignancy. Pleural fluid cultures ultimately grew Cryptococcus Neoformans, and the patient was started on Fluconazole. The chest tube was removed after fluid re-accumulation slowed. The patient was discharged after clinical improvement but was unfortunately lost to follow-up. Discussion Pleural effusion associated with cryptococcal infection in an immunocompetent host was described for the first time in 1941. Since then, approximately 50 cases of pleural effusion related to cryptococcal infection, in the context of both lung and disseminated disease, have been described. Pulmonary cryptococcosis presenting as an isolated hemorrhagic pleural effusion has not been documented well in literature and our case hopes to bring awareness to this rare presentation. This case highlights the importance of considering fungal etiologies, including C. neoformans, in patients with unexplained or recurrent pleural effusions, even in the absence of overt immunosuppression. Increased clinical awareness and early diagnostic evaluation can facilitate timely antifungal therapy and improve patient outcomes, including prevention of disseminated disease. This abstract is funded by: N/A
Chaudhry et al. (2026) studied this question.