NEONATAL CRYPTOCOCCOSIS Vol 39 No. 4 July 2008 697 Correspondence: Dr Sopapan Ngerncham, Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Pran Nok Road, Bangkok 10700, Thailand. Tel: +66 (0) 2419-7000 ext 5713, 5938 E-mail: sispv@mahidol.ac.th CASE REPORT CRYPTOCOCCUS NEOFORMANS SEPTICEMIA IN AN IMMUNOCOMPETENT NEONATE: FIRST CASE REPORT IN THAILAND Narongsak Nakwan 1 , Sopapan Ngerncham 1 , Pimol Srisuparp 1 , Keswadee Lapphra 2 and Kulkanya Chokephaibulkit 2 1 Division of Neonatology, 2 Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Abstract. Neonatal infection due to Cryptococcus neoformans is extremely rare. We report a case of a 21-day-old neonate diagnosed with cryptococcal septicemia who was successfully treated with amphotericin B. He was born to a human immunodeficiency virus (HIV) seronega- tive mother. This report alerts general pediatricians and neonatologists to consider Cryptococ- cus neoformans infection as a possible cause of sepsis in newborn infants. CASE REPORT A 37-week-gestation male neonate who had a history of congenital diaphragmatic her- nia (CDH) diagnosed in utero was born by elective Cesarean section to a healthy 33-year- old mother with good antenatal care. Sponta- neous rupture of membranes occurred 4 hours before delivery. The birth weight was 3,360 g, and the Apgar scores were 2 and 7 at 1 and 5 minutes, respectively. The infant was intu- bated, and transferred to the neonatal inten- sive care unit (NICU). A chest roentgenogram revealed a left-side thoracic CDH. At 1 hour of age, persistent pulmonary hypertension of the newborn developed and was confirmed by echocardiography. Central line catheters were placed in the umbilical artery and vein for administration of intravenous drugs, parenteral nutrition, and to monitor arterial blood gases. The cardiovascular system was maintained using dopamine (20 μg/kg/min), dobutamine (20 μg/kg/min), and epinephrine (0.4 μg/kg/min). Prostacyclin PGI 2 (Iloprost ® ) was started and titrated to a maximum dose INTRODUCTION Cryptococcus neoformans (C. neofor- mans) is a widespread encapsulated fungus found in soil that contain excreta from pigeons. It is predominantly an opportunistic infection in patients with acquired immunodeficiency syn- drome (AIDS) (Dromer et al, 1996). Although its incidence has increased rapidly in recent years, it has rarely been reported in neonates. Since the first case report in 1948, there have been only seven neonatal cases reported in the English literature (Neuhauser and Tucker, 1948; Heath, 1950; Raubitschek, 1958; Gavai et al, 1995; Kaur et al, 2002; Giusiano et al, 2004). We report a case of non-HIV-infected neonatal cryptococcal septicemia in Thailand, a first case report for this country.