Rapid, Recurrent Unilateral Pleural Effusion Presenting as Cryptococcus Infection in a Non-immunocompromised Host

Our plain-English summary of Rapid, Recurrent Unilateral Pleural Effusion Presenting as Cryptococcus Infection in a Non-immunocompromised Host, by M. Gacutan, K. Bhatti, A. Jordan, et al (Curēus, 2026).

The study

• Authors: M. Gacutan, K. Bhatti, A. Jordan, A.R. Aiman, B.B. Patel
• Journal: Curēus
• Published: 2026;18(9):e115732
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Cryptococcus neoformans infection presenting as a rapidly reaccumulating unilateral pleural effusion in a non-immunocompromised host is a rare presentation of pulmonary cryptococcal disease. We present a rare case of recurrent unilateral pleural effusion as the initial presentation of cryptococcal disease in an immunocompetent patient. An 85-year-old male with a past medical history of hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease stage IIIb, and coronary artery disease s/p stent placement in the second obtuse marginal branch of the circumflex artery presented to the emergency department with dyspnea on exertion and an unintentional 30-pound weight loss over two to three months. His prior occupation included work in a tire factory; he denied exposure to asbestos. He chewed tobacco and had a dog. A chest radiograph showed a large right-sided pleural effusion. He had undergone repeated thoracentesis and pigtail chest tube placements over four hospital admissions. Review of the initial cytology, extensive serology, pleural fluid analysis, Gram stain, culture, HIV testing, and adenosine deaminase testing was negative. Given the recurrent hospitalizations and reaccumulation of the right pleural effusion, the decision was made to proceed with endobronchial ultrasound, which demonstrated lymphocytosis without evidence of malignancy. Bronchoalveolar lavage grew 100 colonies of Cryptococcus neoformans. The patient underwent lumbar puncture with an opening pressure of 37 and a negative cryptococcal antigen. He was started on fluconazole 400 mg daily upon discharge, with a suspected treatment course of 12 months and close outpatient pulmonology follow-up. This report highlights a rare initial presentation of Cryptococcus neoformans manifesting as recurrent unilateral pleural effusion.

Copyright © 2026, Gacutan et al.

In plain English

This was a case report about one patient, an 85-year-old man who had worked in a tire factory but denied exposure to asbestos. The report concerns a fungal infection, not an asbestos-related disease. He came to the emergency department short of breath, having lost 30 pounds without trying over two to three months. A chest X-ray showed a large right-sided pleural effusion, meaning fluid around the lung. Over several hospital admissions the fluid kept coming back and was drained repeatedly. Fluid tests were repeatedly negative for cancer, and tuberculosis was ruled out. Bronchoscopy showed lymphocytes and no evidence of malignancy. Fluid washed from the lung (bronchoalveolar lavage) later grew 100 colony-forming units per mL of Cryptococcus neoformans, a fungus. A lumbar puncture ruled out cryptococcal meningitis, and HIV testing was negative. He was discharged on fluconazole 400 mg daily for 6-12 months. The authors concluded that cryptococcal infection should be considered in patients with pleural effusion, whether or not their immune system is weakened.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 85-year-old man with hypertension, hyperlipidemia, diabetes, chronic kidney disease stage IIIb and coronary artery disease, described as immunocompetent
• Exposure: The infection studied was Cryptococcus neoformans. The patient had worked in a tire factory but denied asbestos exposure; the authors thought he likely inhaled fungal spores from the environment
• Main results:
  • At the first admission, 1650 mL of fluid was drained from the right chest
  • The first pleural fluid was exudative, with 22% lymphocytes, and was negative for metastatic disease
  • At the second admission, after two thoracenteses, cytology was negative for malignancy twice and TB was ruled out
  • At a later admission, a pigtail chest tube immediately drained 1300 mL of fluid
  • Rapid on-site evaluation of the bronchoscopy samples showed lymphocytes and no evidence of malignancy
  • Bronchoalveolar lavage grew 100 colony-forming units per mL of Cryptococcus neoformans
  • Cryptococcal antigen in spinal fluid was negative, ruling out cryptococcal meningitis. HSV and HIV serology were negative
  • The patient was discharged on fluconazole 400 mg daily for 6-12 months
• The authors' conclusion: The authors concluded that cryptococcal infection should be included in the differential diagnosis for both immunocompetent and immunocompromised patients with pleural effusion

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Dyspnea, Chest X-Ray, Thoracentesis, Cytology, Ultrasound, Bronchoalveolar Lavage (BAL), Pulmonology.

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