[Primary pulmonary cryptococcosis exhibiting the radiological characteristics of bronchiolitis obliterans organizing pneumonia].

A 31-year-old male was admitted to Toranomon Hospital because of a cough and bilateral patchy infiltrates shown on the chest radiograph. He had been well prior to admission. Chest CT scan revealed patchy areas of air-space consolidation with air-bronchogram and adjacent ground-glass opacities, suggestive of bronchiolitis obliterans organizing pneumonia (BOOP). Transbronchial lung biopsy specimen confirmed the formation of epithelioid cell granulomas without necrosis and the coexistence of organizing pneumonia. The titer of serum cryptococcal antigen increased to 1:256. According to these findings, a diagnosis of primary pulmonary cryptococcosis was made, although cryptococci were neither recognized in the specimen nor cultured from the bronchial lavaged fluid. Chest radiograph showed spontaneous regression in a short period of time. However, itraconazole was administered for the prolonged cough, and the symptom disappeared. The titer of serum cryptococcal antigen decreased to 1:16 after the therapy. Pulmonary cryptococcosis should be considered as one of the differential diagnoses when chest CT scan shows combined air-space consolidation and ground-glass opacities.