Cryptococcal thoracic empyema is extremely rare and has been described almost always in immunocompromised patients with pulmonary or disseminated cryptococcosis. To our knowledge, isolated cryptococcal thoracic empyema with rib osteomyelitis has never been reported in an immunocompetent patient. We herein present such a case. Computed tomographic (CT) scan suggested the diagnosis of thoracic empyema in association with adjacent rib osteomyelitis, confirmed by postoperative histological examination. Surgical debridement followed by appropriate antifungal therapy achieved a complete eradication of the infection.