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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 29-Year-Old Immunocompetent Man With Meningitis and a Large Pulmonary Mass*

Bindi Naik-Mathuria, MD; Jaime Roman-Pavajeau, MD; Todd M. Leleux, MD; Matthew J. Wall, Jr., MD
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*From the Michael E. DeBakey Department of Surgery (Drs. Naik-Mathuria and Roman-Pavajeau) and Ben Taub General Hospital, Division of Thoracic Surgery (Dr. Wall), and Department of Pathology (Dr. Leleux), Baylor College of Medicine, Houston, TX.

Correspondence to: Bindi Naik-Mathuria, MD, Baylor College of Medicine, 1 Baylor Plaza, Suite 404D, Houston, TX 77030; e-mail: bnaik@bcm.tmc.edu



Chest. 2008;133(4):1030-1033. doi:10.1378/chest.07-2115
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Cryptococcal meningitis was diagnosed in a 29-year-old, previously healthy Hispanic man at an outside hospital, and he recovered clinically after starting a course of fluconazole. All testing for immunosuppressive conditions returned negative (HIV negative; CD4 count, 502 cells/μL). He had no recent travel history or sick contacts and was not a smoker. Pulmonary tuberculosis was diagnosed following a purified protein derivative skin test, and a triple-drug regimen was started although sputum culture findings were negative for acid-fast bacilli. Chest radiography showed an area of rounded consolidation (Fig 1 , white arrow) within the right lower lobe anteriorly and along the diaphragm that was thought to represent pneumonia or round atelectasis.

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