Infection with Cryptococcus neoformans var. gattii leading to a pulmonary cryptococcoma and meningitis

A patient who lived in Ohio, U.S.A., developed a large pulmonary cryptococcoma and meningitis as the result of infection with Cryptococcus neoformans var. gattii, an organism of subtropical and tropical distribution. He had no obvious predisposing illness or condition associated with increased susceptibility to cryptococcosis. Although he was found to have cutaneous anergy, his lymphocytes showed significant transformation responses in vitro when cultured both with mitogens and with killed cryptococci. The meningitis responded to intrathecal amphotericin B. The cryptococcoma, however, did not resolve in response to vigorous antifungal therapy during a period of more than 4 months. Eventually, the cryptococcoma was surgically removed. This case is unusual both for the finding of C. neoformans var. gattii outside its apparent endemic area as well as for the clinical features of the disease.