Progressive pulmonary cryptococcosis in a patient who is immunocompetent

Pulmonary cryptococcal disease can have variable clinical and roentgenographic presentations. Symptoms and radiographic abnormalities can resolve prior to therapy, even in a patient who is immunocompromised. Antifungal therapy is generally not recommended for a patient who is immunocompetent with nonprogressive, nondisseminated pulmonary cryptococcosis. We present a case of pulmonary cryptococcosis that progressed despite fluconazole therapy in a patient who was immunocompetent. This appears to be the second reported case of a discrete endobronchial cryptococcoma.