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Pulmonary Cryptococcosis in the Immunocompetent Host*: Therapy With Oral Fluconazole: A Report of Four Cases and a Review of the Literature

Marina Núñez, MD; James E. Peacock, Jr, MD; Robert Chin, Jr, MD, FCCP
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Affiliations: *From the Sections on Infectious Diseases (Drs. Núñez and Peacock) and Pulmonary Critical Care Medicine (Dr. Chin), Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. ,  Currently at Instituto de Salud Carlos III, C/Sinesio Delgado, 10, Madrid, Spain

Correspondence to: James E. Peacock, Jr, MD, Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1042; e-mail: jpeacock@wfubmc.edu



Chest. 2000;118(2):527-534. doi:10.1378/chest.118.2.527
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Isolated pulmonary cryptococcosis (IPC) is an infrequently diagnosed infection, the management of which is not well defined. In past years, IPC traditionally has not been treated in the immunocompetent host, given its perceived benign and self-limited course and the toxicity associated with amphotericin B. However, some patients manifest prominent and disabling symptoms, and infection occasionally may disseminate. Fluconazole is active against Cryptococcus neoformans, is easily administered, and has an excellent safety profile. We present four healthy hosts with IPC who were treated with oral fluconazole for 6 to 8 weeks. A review of the literature was conducted to identify other cases of IPC in healthy hosts who were also treated with fluconazole. Our results and the limited experience reported in the literature suggest that fluconazole may be an appropriate choice for the treatment of IPC in the immunocompetent host. Indications for treatment are not defined, but symptomatic patients, those with multiple nodules or extensive infiltrates on chest radiographs, and/or those testing positive for serum cryptococcal antigen might be potential candidates for therapy.

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