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Cryptococcal meningitis in an immunocompetent patient with obstructive hydrocephalus: A case report
N Hamdan1, R Billon Grand1, J Moreau2
1Service de neurochirurgie, CHRU Jean-Minjoz, 25030, Besançon, France.
Neuro-Chirurgie
|September 10, 2018
Summary
Cryptococcal meningitis, rare in immunocompetent individuals, can cause hydrocephalus. Prompt diagnosis via antigen detection and PCR is key for effective antifungal treatment and improved outcomes.
Area of Science:
- Neuroscience
- Infectious Diseases
- Medical Imaging
Background:
- Cryptococcal infections of the central nervous system are uncommon in immunocompetent patients.
- Typically present as meningitis or fungal cysts, often with hydrocephalus.
- Timely diagnosis and treatment are critical for patient prognosis.
Observation:
- A case of an immunocompetent 40-year-old male with a worsening headache and signs of increased intracranial pressure is presented.
- MRI revealed extensive cortico-pial cerebellar enhancements and obstructive hydrocephalus, requiring emergency ventriculocisternostomy.
Findings:
- Initial biopsies and CSF analysis were inconclusive; tumor markers and immunosuppression screening were negative.
- Diagnosis was confirmed via simultaneous plasma and CSF Cryptococcus antigen detection, with Cryptococcus neoformans identified by PCR.
- Clinical improvement was observed with both corticosteroid and antifungal therapies.
Implications:
- This case highlights the diagnostic challenges of cryptococcal meningitis in immunocompetent patients, particularly those without a history of HIV or organ transplant.
- Neurologists and neurosurgeons should consider cryptococcal meningitis in cases of diffuse, thick leptomeningeal enhancement on MRI.
- The study underscores the importance of antigen testing for timely diagnosis and management of CNS cryptococcosis.
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