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A case of recurrent cryptococcal meningoencephalitis in an immunocompetent female

Negin Niknam1, Negar Niknam1, Kola Dushaj1

  • 1Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, NY 11432, USA.

Case Reports in Infectious Diseases
|October 3, 2014
PubMed

Insights

Cryptococcal meningoencephalitis can recur in immunocompetent individuals, particularly with central nervous system (CNS) shunt placement. Early removal of shunts after meningitis resolution may prevent cryptococcal meningitis relapse.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Mycology

Background:

  • Cryptococcus neoformans commonly causes meningoencephalitis in immunocompromised patients.
  • Recurrence of cryptococcal infection is observed in HIV-positive individuals.
  • Central nervous system (CNS) shunts are used for persistently elevated intracranial pressure.

Purpose of the Study:

  • To describe a case of recurrent cryptococcal meningoencephalitis in an immunocompetent patient.
  • To highlight the potential role of CNS shunts in recurrent infections.
  • To suggest management strategies for cryptococcal meningitis in patients with shunts.

Main Methods:

  • Case report of a 39-year-old immunocompetent female.
  • Detailed clinical presentation, diagnostic workup, and treatment course.
  • Follow-up assessment for recurrence after initial treatment and shunt placement.

Main Results:

  • The patient presented with neurologic deficits and increased intracranial pressure due to cryptococcal meningoencephalitis.
  • The course was complicated by drug-induced hepatitis and persistent increased intracranial pressure requiring shunt placement.
  • Relapse of cryptococcal meningoencephalitis occurred after completion of antifungal treatment.

Conclusions:

  • Recurrent cryptococcal meningitis can occur in immunocompetent patients, especially with prolonged CNS shunt use.
  • Central nervous system shunts may serve as a nidus for recurrent fungal infections.
  • Removal of CNS shunts after resolution of meningitis should be considered to prevent relapse.

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