Massive pleural effusions in cryptococcal meningitis

Cryptococcal infection uncommonly presents with pulmonary manifestations an d even more rarely so as massive bilateral effusions. Pleural involvement i s usually associated with underlying pulmonary parenchymal lesions and is u nusual while on antifungal therapy. We report a patient with cryptococcal m eningitis who, while on intravenous 5-flucytosine and amphotericin B, devel oped life-threatening bilateral massive pleural effusions with evidence of spontaneous resolution, consistent with prior hypothesis of antigenic stimu lation as the cause of pleural involvement.