Primary Cryptococcus neoformans pneumonia treated by Itraconazole,a two-year follow-up study

Objective To report two non-immunocompromised cases of primary cryptococcus neoformans pneumonia with their clinical presentations, pathology and imaging manifestations.Methods CT, percutaneous lung biopsies were performed. The pulmonary cryptococcosis neoformans was obtained by broncho-alveolar la-vage. All two cases were treated with itraconazole and followed-up by CT. Results Cerebrospinal fluid examination and renal ultrasonic examination were negative. One case had cough, dyspnea, and fever; with multiple large patchy shadows on chest film. The other had no symptoms but with multiple delineated nodular shadows on screening test. Pathologic examination through percutaneous lung puncture and bronchial washings revealed Cryptococcus neoformans. Two weeks of Itraconazole injection and three months of oral Itraconazole administration showed disappearance of all abnormal shadows in the lung fields. No recrudescence occurred on two years follows up. Conclusion Cryptococcus neoformans pneumonia always showed no symptoms or with mild cough, dyspnea, and fever; only can be shown by CT as multiple nodules or large patches. Sequential treatment with Itraconazole is effective and reliable.