在新型隱球菌及格特隱球菌複合種群(Cryptococcus neoformans- Cryptococcus gattii species complex) 之中，新型隱球菌的分布是全球性的，而格特隱球菌的分布主要被認為是在熱帶及
亞熱帶地區包括台灣。格特隱球菌(Cryptococcus gattii) 的感染在台灣很少見，我們報告一個32歲免疫正常的越南男性因為壞死性肺炎轉至我們醫院進行肺切除術。肋膜積水培養出格特隱球菌。起初我們每日投與口服fluconazole 200mg。病人於肺切除術後10 日發生腦膜炎。腦脊髓液亦培養出之格特隱球菌與肋膜積水相同。病人接受amphotericin B和flucytosine 治療兩週後，改成針劑fluconazole 400mg 繼續治療。最終病人於住院後40 天順利出院。經110 天每日口服fluconazole 200mg 後，門診追蹤發現無任何神經併發症之報告。格特隱球菌容易產生中樞神經之感染。因此嚴重的肺部隱球菌感染應當作中樞神經感染治療。

Cryptococcus gattii infection has rarely been reported in Taiwan. We report a case of 32-year-old immunocompetent male Vietnamese referred for pneumonectomy under the impression of necrotizing pneumonia. Pleural effusion was collected during the pneumonectomy and the culture of pleural effusion yielded Cryptococcus. Although oral fluconazole 200 mg daily was prescribed, meningitis developed 10 days after pneumonectomy. Culture of cerebrospinal fluid (CSF) yielded Cryptococcus. The patient received amphotericin B plus flucytosine for two weeks as antifungal induction therapy,followed by intravenous fluconazole 400 mg per day as consolidation therapy. The molecular typing of Cryptococcus was C. gattii VGII. He was discharged on the 40th day after admission and was prescribed oral fluconazole 200 mg daily for 110 days at outpatient department. No neurological sequela was found at the time of last follow-up. Importantly, Cryptococcus has tendency to infect the central nervous system (CNS), especially the subspecies C. gattii, which could be differentiated from C. neoformans by its activity in the medium containing canavanine, glycine and bromothymol blue (CGB). Patients with necrotizing pneumonia caused by C. gattii should be treated as central nervous system infection.In conclusion, appropriate fungicidal agents to cover CNS infection should be administered
for this kind of patient from the time of first disease onset.