Admission blood work was remarkable for a normal cell count and differential, hemoglobin of 7.1 g/dL, and platelets of 640,000/μL. The biochemistry profile and liver enzyme findings were normal. Chest radiography showed a round opacity with adjacent airspace disease in the right lower lobe (Fig 1
). Subsequent testing included a nonreactive tuberculin skin test, negative fungal serology results, negative serum cryptococcal antigen, and a negative HIV screen. A CT-guided, fine-needle aspiration of the parenchymal lesion was performed. Direct smear showed “few fungal elements” and mixed inflammatory cells. Seventeen days later, fungal cultures grew Cryptococcus neoformans. Infliximab therapy was discontinued. The patient was treated with amphotericin-B, followed by fluconazole maintenance therapy, with significant improvement of respiratory symptoms.