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A Rare Presentation of Cryptococcal Meningoencephalitis in an Immunocompetent Individual

Ashwin Malhotra1,2, Qin Rao2, Sean Kelly3

  • 1Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.

Clinics and Practice
|September 30, 2017
PubMed

Insights

This rare case highlights disseminated Cryptococcus meningoencephalitis in an immunocompetent patient, diagnosed via high antigen titers in cerebrospinal fluid. Further research is needed for optimal treatment in this population.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Mycology

Background:

  • Cryptococcal meningoencephalitis is a significant cause of death in immunocompromised individuals.
  • Cases in immunocompetent patients are rare, often presenting atypically.

Observation:

  • A rare case of disseminated Cryptococcus meningoencephalitis occurred in an immunocompetent patient.
  • Initial brain imaging (MRI, EEG) was negative for metastasis.
  • Diagnosis was confirmed by high Cryptococcus neoformans antigen titers (1:2048) in cerebrospinal fluid.

Findings:

  • Occupational exposure to bird dander was identified as a potential risk factor.
  • Cerebrospinal fluid and serum Cryptococcus antigen levels are crucial for diagnosis and monitoring treatment.
  • Current treatment guidelines are designed for immunocompromised individuals.

Implications:

  • Delayed diagnosis of Cryptococcus meningoencephalitis increases morbidity and mortality.
  • Optimal treatment duration for immunocompetent patients requires further investigation to minimize side effects.
  • This case underscores the importance of considering Cryptococcus in immunocompetent individuals with neurological symptoms.
Keywords:
Altered mental statuscryptococ-cal meningoencephalitislumbar puncture

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