Year: 2024
Type: article
Study design: Case Report
Abstract: Objective N/A. Background Cryptococcal meningitis is a life-threatening, severe opportunistic fungal infection characterized by inflammation of the meninges caused by Cryptococcus neoformans or Cryptococcus gattii. Although frequently associated with the immunocompromised, cryptococcosis can manifest in immunocompetent hosts as well. Design/Methods N/A. Results A 49-year-old gentleman presented with acute onset confusion in the setting of a worsening subacute-on-chronic, complicated headache of 2 months duration. Initial diagnoses by outside providers suggested occipital neuralgia versus migraines due to mild improvement with migraine pharmacotherapies and occipital nerve blocks. Due to symptom recurrence with a new onset confusional state, neck stiffness, photophobia, and nausea on presentation, brain imaging was obtained, which displayed diffusely abnormal nodular leptomeningeal enhancement suspicious for meningitis. The patient was afebrile, with no leukocytosis, and negative for Kernig and Brudzinski signs. Lumbar puncture revealed elevated intracranial pressure, rare, encapsulated yeast on India Ink CSF stain, and elevated Cryptococcal serum and CSF antigen levels. Comprehensive immunological workup was grossly unremarkable. Despite aggressive management with antifungal therapy including Amphotericin B and Flucytosine, as well as serial lumbar punctures followed by extra ventricular placement and VP shunt for elevated ICPs, the patient experienced a poor clinical outcome with post-shunting complications and ultimately expired. Conclusions Cryptococcal meningitis in immunocompetent hosts poses several clinical challenges. With the mortality rate of cryptococcal meningitis in immunocompetent individuals falling between 12 and 25 percent, this case report highlights the pivotal influence of early diagnosis in underreported patient population and the increasing prevalence of immunocompetent CNS fungal infections. Our case report further illustrates the insidious course that cryptococcal meningitis can take in immunocompetent individuals and calls attention to the importance of identifying more specific clinical findings for early diagnosis in otherwise healthy individuals.
Source: Neurology
Authors: Jim Varghese, Alexander Maslov, Ehtesham Khalid
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206691