Pulmonary Cryptococcosis Complicated by Pneumococcal Pneumonia Co-Infection with Influenza AVirus

A 73-year-old man visited Kawasaki Medical School Hospital with complaints of cough and fever persisting for five days. He was diagnosed with myasthenia gravis in 2010 and had received immunosuppressive treatment for eight years. He presented with infiltration shadows in the bilateral middle and lower lung fields. Because both influenza A virus antigen and urinary pneumococcal pneumonia antigen were positive in laboratory findings, he was diagnosed with pneumococcal pneumonia co-infection with influenza a on admission. We administered peramivir and sulbactam/ampicillin after admission. Although the inflammatory response improved, infiltration shadows did not improve. We performed bronchoscopic examination and obtained the diagnosis of the complication of pulmonary cryptococcosis by transbronchial lung biopsy. He was treated with fluconazole for six months for pulmonary cryptococcosis and he showed improvement without adverse reactions. We report an interesting immunocompromised patient with pulmonary cryptococcosis complicated by pneumococcal pneumonia co-infection with influenza A.