[Clinical problems in Medical Mycology: Problem number 57]

A 48-year-old man with no relevant medical history went to a general acute hospital seeking medical attention. He had fever, cough, and chest pain. A chest X-ray revealed pleural effusion, which prompted a puncture and a subsequent culture of the sample; antibiotic treatment was prescribed. Despite the treatment, the man remained febrile, and a new clinical examination suggested a probable onychomycosis of all 20 nails. A rapid HIV test was carried out. The culture from the pleural puncture showed yeast growth identified as Cryptococcus sp., revealing a disseminated disease with central nervous involvement, thus leading to an early diagnosis with a better prognosis.