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. 2023 Feb 23;43(5):921–932. doi: 10.1007/s10875-023-01451-5

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© The Author(s) 2023

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Clinical, microbiologic, and radiologic findings and tissue staining results for patients. Patient 1: a Papular skin lesions on the nasal ala (arrows); b Brain CE-MRI showing multiple nodular lesions affecting the supratentorial areas and the basal ganglia (arrows); c Chest CE-CT scan showing a mediastinal mass surrounding vessels (arrow) and a pulmonary nodule in the upper part of the left lower lobe (arrow); the fistula is not shown; d India ink staining of the mediastinal mass biopsy specimen, showing unstained thick mucopolysaccharide capsules (arrow) from Cryptococcus (40X). Patient 2: e Whole-body CE-MRI: coronal T2-weighted sequence showing hyperintense right supraclavicular fluid collection in the right shoulder affecting the acromioclavicular joint, with infiltration of the bursa and bone (arrows); f Sagittal T2-weighted sequence showing fluid collection extending to the retroperitoneal, dural, and posterior mediastinum, together with spinal cord compression and instability and bone destruction between T9 and T11, with 90% collapse of the space between T10 and T11 (arrows); g Brain CE-MRI showing acute hydrocephalus and basal meningitis with cranial nerve involvement (arrow); h Chest CT-scan showing a mass protruding into the right mediastinal space and bilateral mild pleural effusion (arrow). Patient 3. i Brain MRI sagittal T2-plane showing pathological meningeal enhancement and vasogenic edema (arrow); j Chest CE-CT scan showing an irregular pulmonary nodule in the upper right lobe and a diffuse ground-glass pattern (arrow); k Chest CE-CT scan showing patchy bilateral ground-glass opacities with thickening of the interlobular septa with a “crazy-paving” pattern, predominantly in the lower zone (arrow); l Abundant extracellular proteinaceous periodic acid-Schiff (PAS)-positive material on lung biopsy (100 ×)