Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy...

While the incidence of pulmonary and extrapulmonary tuberculosis is growing in patients of advanced age, immunocompromised subjects, and immigrants coming in from developing countries [Keller A, Delavelle J, Howarth N, Bianchi S, Garcia J. Spinal and neurotuberculosis in an Asian immigrant. JBR-BTR 2002;85:136-7; Sabbatani S, Manfredi R, Legnani G. Chiodo F. Tuberculosis in a metropolitan area of northern Italy: epidemiological trends and public health concerns. Eur J Epidemiol 2004;19:501-3], the concomitant occurrence of cerebral cryptococcosis plus brain and respiratory tuberculosis in a young and otherwise healthy patient, without an evident cause of immunodeficiency and without an obvious exposure, is exceedingly rare [Silber E, Sonnenberg P, Koornhof HJ, Morris L, Saffer D. Dual infective pathology in patients with cryptococcal meningitis. Neurology 1998;51:1213-5.].

An exceptionally rare case of concurrent central nervous system infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a 25-year-old otherwise healthy Chinese student, who had very recently joined an Italian post-doctoral course, is described. Also described are the diagnostic and therapeutic difficulties encountered in a five-month hospitalization period, when only transient and/or negligible immune system impairments were detected.

This episode of very infrequent concurrent infections should emphasize the need to maintain an elevated clinical suspicion for opportunistic infections and tuberculosis, even in the absence of an obvious immunodeficiency and related epidemiological clues.