Invasive Cryptococcal Meningitis Presenting as a Skull Base Mass in An Immunocompetent Host: A Case Report

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Cryptococcus neoformans encephalitis is typically observed in immunocompromised patients, such as those with AIDS.
• Invasive fungal sinusitis with central nervous system (CNS) involvement is a rare but critical consideration in patients with meningitis and skull base lesions, even without apparent immune compromise.

Observation:

• A 59-year-old immunocompetent male presented with unresponsive status, a sphenoid mass eroding the skull base, and symptoms of meningitis and encephalitis caused by C. neoformans.
• MRI revealed extensive diencephalic invasion and a skull base sphenoid mass. Lumbar puncture confirmed elevated opening pressure and C. neoformans infection.

Findings:

• The patient underwent sinonasal debridement, external ventricular drain placement for hydrocephalus, and aggressive treatment with intravenous and intrathecal amphotericin B.
• Following treatment, the patient regained consciousness, CSF cultures normalized, and he was managed with a ventriculoperitoneal shunt and an Ommaya reservoir for continued intrathecal therapy.

Implications:

• This case demonstrates a successful treatment algorithm for a rare presentation of cryptococcal encephalitis in an immunocompetent host.
• A multidisciplinary approach involving neurosurgery, otolaryngology, and infectious disease specialists is crucial for managing invasive fungal sinusitis and CNS involvement.
• The presented strategy may improve outcomes and allow for longer-term independent survival in similar complex cases.