Cryptococcosis in patients with cancer

Records of 31 patients with cancer who did not have known human immunodefic iency virus infection and who developed culture-proven cryptococcosis durin g the period of 1989-1999 (incidence of 18 cases per 100,000 admissions) we re retrospectively reviewed. Several presentations of cryptococcosis were s een, including pulmonary in 19 patients (13 of which were symptomatic), dis seminated in 6, meningeal in 3, and other, less common manifestations in 3. Hematologic malignancy (in 20 patients [65%]) was the most common underlyi ng disease. Lymphopenia was present in 19 patients (61%). Previous steroid use was noted in 16 patients (51%). The diagnosis of cryptococcosis was rar ely suspected; lung and brain malignancy were frequent initial impressions. Cryptococcosis was diagnosed postmortem in only 2 cases (6%). In cases of both pulmonary and meningeal cryptococcosis, the yield of invasive diagnost ic procedures was good. Antifungal treatment was heterogeneous, but only 18 % of patients who received it had treatment failure. Fluconazole monotherap y was successful in 92% of patients. In conclusion, cryptococcosis is rare in patients with cancer and appears to have a relatively good diagnostic yi eld and therapeutic outcome.