Two cases of refractory Cryptococcus gatti (C gatti) infection and literature review: Case report.

RATIONALE: The incidence of Cryptococcus gatti (C gatti) infection has been increasing, posing significant challenges in clinical diagnosis and treatment due to its high virulence, refractoriness, and mortality.

PATIENT CONCERNS: Both patients had no immune function defects. One of the cryptococcal drug sensitivity results suggested resistance to fluconazole, which ultimately required surgical intervention. Two patients had recurrent symptoms and worsened examination results during antifungal treatment, and the course of anti-infection was more than 6 months.

DIAGNOSES: Pulmonary cryptococcosis complicated with cryptococcal encephalitis caused by C gatti.

INTERVENTIONS: We used standard treatment in induction, consolidation, and maintenance periods, dynamically evaluating efficacy, monitoring fluconazole MIC, and timely surgical intervention.

OUTCOMES: Two patients recovered after treatment.

LESSONS: A literature review was conducted using PubMed, China National Knowledge Infrastructure, Wanfang, and VIP databases with the search term "gatti" to identify reported cases both domestically and internationally. Relevant data were extracted for further analysis. The treatment of C gatti is challenging. We need to continuously adjust the treatment plan based on the patient's symptoms, test results, and response to treatment to obtain an accurate diagnosis and maximize treatment effectiveness.