A 91-year-old woman was admitted to our hospital in July 2008 with fever and confusion. Chest radiography indicated multiple infiltrative shadows in the middle and lower lung fields bilaterally, and a computed tomogram (CT) of the chest showed multiple nodular lesions. The patient was suspected to have bacterial pneumonia and was treated with antibacterial agent; however, her condition did not improve. Serum laboratory test results demonstrated marked hypercalcemia, undetectable levels of parathyroid hormone and parathyroid hormone-related protein, and 1,25-dihydroxyvitamin D₃ levels in the high-normal range. A CT-guided needle biopsy was performed, and a Grocott-Gomori methenamine-silver nitrate stain of a biopsy specimen from the right lower pulmonary lobe showed a yeast-like fungus. Cryptococcus neoformans was confirmed by culture, and primary pulmonary cryptococcosis was diagnosed. Her serum cryptococcal antigen titer was positive at 1:8,192. The patient was treated with fluconazole, and her symptoms, multiple nodular lesions, and serum laboratory findings improved.