Cryptococcal pneumonia in patients with the acquired immunodeficiency syndrome

Infection with Cryptococcus neoformans occurs with increased frequency in patients with the human immunodeficiency virus (HIV). Despite the lungs being the portal of entry for the fungus the commonest presentation is with meningitis: Cryptococcal broncho pulmonary infection occurs less commonly. The chest radiographs of fourteen HIV positive patients with cryptococcal pneumonia were reviewed. The commonest radiographic abnormalities were interstitial infiltrates, (nine patients) and focal or widespread alveolar consolidation (seven patients). Ground glass shadowing, not previously described in cryptococcal pneumonia, occurred in six radiographs, miliary nodules in one, lymphadenopathy in four, and small pleural effusions in three. Two patients had a normal chest radiograph. In contrast to previous reports, we found alveolar consolidation and ground glass shadowing to be common and nodules and cavitation to be rare. Cryptococcal pneumonia should be considered in the differential diagnosis of Pneumocystis carinii pneumonia, bacterial pneumonia and miliary tuberculosis in HIV positive patients.