{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T12:50:08Z","timestamp":1766407808301,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,9]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>\n                  <jats:italic>Cryptococcus neoformans<\/jats:italic> is a ubiquitous environmental organism found worldwide. Infection with this organism occurs predominantly in immunocompromised hosts, including persons living with HIV or those with impaired cellular immunity. Cryptococcal pleural effusions have been described in cases with extensive pulmonary involvement. Here we present the case of a woman receiving temozolomide and steroids for glioblastoma multiforme, who developed cough and dyspnoea and was found to have an uncomplicated pleural effusion. Pleural fluid culture grew <jats:italic>Cryptococcus neoformans<\/jats:italic> with negative culture on bronchoalveolar lavage. High serum cryptococcal antigen titre of 1:64 prompted lumbar puncture which demonstrated positive cerebrospinal fluid for <jats:italic>Cryptococcus neoformans<\/jats:italic>. She was treated with liposomal amphotericin B and flucytosine, followed by consolidation and maintenance therapy with fluconazole. Pleural involvement in the absence of pulmonary involvement has rarely been reported. We review pulmonary and radiographic manifestations of cryptococcal infection, when to assess for disseminated infection, and management principles.<\/jats:p>","DOI":"10.1136\/bcr-2023-256255","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T12:30:48Z","timestamp":1700656248000},"page":"e256255","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Disseminated <i>Cryptococcus neoformans<\/i> presenting with an isolated pleural effusion in a patient receiving temozolomide and long-term steroids"],"prefix":"10.1136","volume":"16","author":[{"given":"Brooke","family":"Fraser","sequence":"first","affiliation":[{"name":"Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maha","family":"Munawar","sequence":"additional","affiliation":[{"name":"Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheliza","family":"Halani","sequence":"additional","affiliation":[{"name":"Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha","family":"Sabur","sequence":"additional","affiliation":[{"name":"Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Respirology, St Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"2025082801581284000_16.11.e256255.1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00651"},{"key":"2025082801581284000_16.11.e256255.2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3390\/jof5030071","article-title":"Central nervous system cryptococcal infections in non-HIV infected patients","volume":"5","author":"Beardsley","year":"2019","journal-title":"J Fungi (Basel)"},{"key":"2025082801581284000_16.11.e256255.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.10.006"},{"key":"2025082801581284000_16.11.e256255.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.fgb.2015.02.009"},{"key":"2025082801581284000_16.11.e256255.5","first-page":"547","article-title":"Temozolomide-related infections: review of the literature","volume":"16","author":"Kizilarslanoglu","year":"2011","journal-title":"J BUON"},{"key":"2025082801581284000_16.11.e256255.6","doi-asserted-by":"publisher","DOI":"10.3201\/eid2001.130906"},{"key":"2025082801581284000_16.11.e256255.7","doi-asserted-by":"publisher","DOI":"10.1378\/chest.129.2.333"},{"key":"2025082801581284000_16.11.e256255.8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/BF01710547","article-title":"Cryptococcal pleural effusion as first indicator of AIDS: a case report","volume":"21","author":"de Lalla","year":"1993","journal-title":"Infection"},{"key":"2025082801581284000_16.11.e256255.9","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/17.2.321"},{"key":"2025082801581284000_16.11.e256255.10","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000016354","article-title":"Cryptococcal pleuritis with pleural effusion as the only clinical presentation in a patient with hepatic cirrhosis: a case report and literature review","volume":"98","author":"Wang","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025082801581284000_16.11.e256255.11","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1186\/s12879-015-1132-4","article-title":"Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review","volume":"15","author":"Chen","year":"2015","journal-title":"BMC Infect Dis"},{"key":"2025082801581284000_16.11.e256255.12","doi-asserted-by":"crossref","first-page":"5510","DOI":"10.12998\/wjcc.v10.i16.5510","article-title":"Pleural involvement in cryptococcal infection","volume":"10","author":"Georgakopoulou","year":"2022","journal-title":"World J Clin Cases"},{"key":"2025082801581284000_16.11.e256255.13","first-page":"743","article-title":"Pleural effusions due to cryptococcus neoformans: a review of the literature and report of two cases with cryptococcal antigen determinations","volume":"121","author":"Young","year":"1980","journal-title":"Am Rev Respir 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Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256255","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:58:17Z","timestamp":1756371497000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,22]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bcr-2023-256255"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256255","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}