Case report article: Fatal Cryptococcal Meningitis Complicated by Hydrocephalus in an Apparently Immunocompetent Farmer: A Case Report
Year: 2026
Type: preprint
Study design: Case Report
Abstract: Introduction: Cryptococcal meningoencephalitis is an opportunistic fungal infection that predominantly affects immunocompromised individuals. However, an increasing number of cases have been reported in apparently immunocompetent hosts, posing important diagnostic and therapeutic challenges. Case presentation: We report the case of a 64-year-old previously healthy farmer living in a rural area who presented with a 10-day history of severe diffuse headache, fever, photophobia, and phonophobia followed by horizontal binocular diplopia. Neurological examination revealed neck stiffness and bilateral grade IV papilledema. Brain MRI demonstrated early active tetraventricular hydrocephalus with transependymal cerebrospinal fluid resorption. CSF analysis showed lymphocytic meningitis with markedly elevated protein levels, profound hypoglycorrhachia, and positive multiplex PCR, India ink staining, culture for Cryptococcus neoformans. Despite prompt induction therapy with liposomal amphotericin B plus fluconazole, progressive hydrocephalus developed, requiring neuronavigation-guided external ventricular drainage. An extensive immunological workup, including repeated HIV testing and lymphocyte subset analysis, excluded persistent immunodeficiency, with the initial transient lymphopenia resolving during treatment. The patient improved clinically, cerebrospinal fluid cultures became sterile, and he was discharged on oral fluconazole. Unexpectedly, he died at home one month later from an undetermined cause. Conclusion: This case illustrates that in cryptococcal meningoencephalitis, successful antifungal therapy and cerebrospinal fluid sterilization do not invariably predict neurological recovery. Vigilant monitoring for intracranial complications and persistent inflammatory injury remains crucial throughout the disease course.
Source: Research Square
Institution: Université Mohammed VI des Sciences et de la Santé
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7203755258