Pulmonary cryptococcosis presenting with multiple pulmonary nodules.

A 50-year-old white man was admitted to the hospital for evaluation of abnormal findings on chest film. Three weeks prior to admission, he developed left pleuritic chest pain associated with some mild cough. No fever was noted at that time. Radiologic evaluation disclosed multiple, bilateral pulmonary nodules, some of which were suspected to be cavitary in nature. The patient had a seven-year history of regional ileitis, and a right hemicolectomy and distal ileectomy had been performed. His medications upon admission to the hospital were prednisone, 17.5 mg every other day, salicylazosulfapyridine (Azul,fidine) 2 gm daily. The patient was a nonsmoker and nondrinker. He had no history of previous pulmonary disease. He operated a fruit farm and actively engaged in work duties, which included tilling soil, picking fruits, and spraying trees. He denied any weight loss, shortness of breath, hemoptysis, pedal edema, paroxysmal nocturnal dyspnea, or orthopnea. Physical examination revealed the patient to be in no acute distress. Except for a surgical scar in his abdomen, physical examination was normal. Chest x-ray films obtained at admission and full chest