The patient was a 54-year-old male who was taking oral prednisolone (10 mg/day) and methotrexate for rheumatoid arthritis. He was transported by ambulance to our hospital for headache, fever, and abnormal speech and behavior. A mild disturbance in level of consciousness and right abducens nerve palsy were noted. A cerebrospinal fluid test was performed for suspected meningitis; the cerebrospinal fluid acid-fast bacilli smear was positive. Using a transcription-reverse transcription concerted reaction (TRC), positive nucleic acid identification of Mycobacterium tuberculosis was obtained; consequently, tuberculous meningitis was diagnosed. Chest computed tomography revealed nodular shadow in the left upper lobe and scattered small granular shadows in the bilateral lung fields. Although the acid-fast bacilli smear of the sputum was negative, pulmonary tuberculosis/miliary tuberculosis was diagnosed based on a positive TRC result for M. tuberculosis. After treatment with oral administration of isoniazid, rifampicin, ethambutol, and pyrazinamide, and intravenous dexamethasone, the fever subsided and the level of consciousness improved.

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The patient was a 93-year-old female receiving oral steroids for polymyalgia rheumatica and undergoing treatment for diabetes mellitus. She was admitted to our hospital for fever, cough, and disturbance in her level of consciousness. Chest computed tomography revealed a giant mass of 10 cm in length in the right upper lobe and multiple nodular shadows in the bilateral lung fields. Based on bronchoscopy-guided transbronchial lung biopsy of the mass in the right upper, pulmonary cryptococcosis was diagnosed. As the patient had concomitant meningitis, treatment with voriconazole was initiated, and her symptoms gradually improved. Long-term treatment was possible with no significant adverse events.

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