Cryptococcal pleural effusion in acquired immune deficiency syndrome—Diagnosis by closed pleural biopsy

Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture from the pleural fluid or bronchoalveolar lavage fluid (BAL), or by histopathology of the lung biopsy specimen. Diagnosis of cryptococcal pleural effusion by closed pleural biopsy (CPB) has been reported only once [Katz AS, Niesenbaum L, Mass B. Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy. Chest 1989;96:440–1]. We report another case where CPB confirmed the diagnosis of pleural cryptococcosis. This could be the first case where CPB and trans-bronchial lung biopsy (TBLB) in the same patient diagnosed pleural and pulmonary cryptococcosis, respectively. This case highlights that closed pleural biopsy is a useful test in the definitive diagnosis of cryptococcal pleural effusion.