[Case of primary pulmonary cryptococcosis accompanied by severe back pain]

We report a case of primary pulmonary cryptococcosis. A 43-year-old male, without any significant underlying disease or immunological abnormalities, was admitted to our hospital with a complaint of sudden onset of severe back pain. His chest-X-ray and computed tomography revealed infiltrative shadows in the left lower lung without any signs of pleural effusion. Through transbronchial biopsy, cryptococcosis was obtained. Cryptococcal antigen also tested positive, we diagnosed this case as primary pulmonary cryptococcosis. And started anti-fungal therapy (fluconazole) consisting of parenteral and oral fluconazole. As soon as anti-fungal therapy was started, both the chest X-ray findings and cryptococcal antigen showed general improvement. Furthermore, subjective symptoms subsided immediately after treatment, During follow up through the outpatient clinic, his symptomatic complaint and chest roentgenogram shows improvements. This case was noteworthy for two reasons: 1) In cases with chest X-rays showing infiltrative shadows but lacking any underlying diseases, pulmonary cryptococcosis should be considered. 2) Sudden onset of back pain is a rare but a possible primary symptom of pulmonary cryptococcosis.