• Jie Wang, Jin-Jing Hong, Piao-Piao Zhang, Mei-Fang Yang, Qing Yang, and Ting-Ting Qu.
• Respiratory Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou.
• Medicine (Baltimore). 2019 Jul 1; 98 (28): e16354.

RationaleCryptococcosis is a significant life-threatening fungal infection in worldwide, mainly reported in immunocompromised patients. Pleural effusion presentation of cryptococcal infection as the only clinical presentation is rarely seen in pulmonary cryptococcosis, which may lead to be misdiagnosed, and the study on this subject will provide further insights.Patient ConcernsA 64-year-old man was hospitalized in our department and diagnosed as hepatic B cirrhosis. A computed tomography (CT) of the thorax showed a massive right pleural effusion without pulmonary parenchymal abnormalities. He was started on empirical treatment for pleural tuberculosis (TB). However, during his hospitalization, a right pleural effusion developed and fever was not controlled.DiagnosesOn day 14 admission, pleural fluid cultured positive for Cryptococcus neoformans. The C neoformans isolate belonged to ST5 and molecular type VNI (var. grubii).InterventionsThe patient was diagnosed with cryptococcal pleuritis, then amphotericin B and fluconazole were administrated.OutcomesFinally, the patient was improved and discharged from our hospital.LessonsSimilar cases in cryptococcal pleuritis patients with pleural effusion as the only clinical presentation in the literature are also reviewed. Through literature review, we recommend that pleural effusion cryptococcal antigen test should be used to diagnose cryptococcal pleuritis to reduce misdiagnosis. The early administration of antifungal drug with activity to Cryptococcus seemed beneficial in preventing dissemination of cryptococcosis.

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