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A Rare Case of Cryptococcal Meningitis in a Child with a Congenital Heart Disease

Bhim Gopal Dhoubhadel1,2, Ujjwal Laghu3, Raju Poudel3

  • 1School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.

Case Reports in Infectious Diseases
|August 9, 2021
PubMed

Insights

Congenital heart disease, like ventricular septal defect (VSD), may predispose children to cryptococcal meningitis. Early diagnosis using cryptococcal antigen (CrAg) testing is crucial for better outcomes.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurology
  • Cardiology

Background:

  • Cryptococcal meningitis is a severe infection with high mortality, particularly in immunocompromised individuals.
  • Congenital heart disease is not widely recognized as a risk factor for cryptococcal meningitis in children.

Observation:

  • A 12-year-old female with a ventricular septal defect (VSD) presented with symptoms suggestive of meningitis.
  • Initial diagnostic tests, including CSF Gram stain, India ink, and culture, were negative.
  • The patient did not improve with standard meningitis treatment.

Findings:

  • Subsequent investigations revealed Cryptococcus in the CSF, confirmed by a positive cryptococcal antigen (CrAg) test.
  • Despite treatment with amphotericin B and flucytosine, the patient died.

Implications:

  • Ventricular septal defect (VSD) should be considered a potential predisposing factor for cryptococcal meningitis in pediatric cases.
  • Increased availability and utilization of CrAg testing are essential, especially in resource-limited settings, due to its higher sensitivity.
  • Timely diagnosis and appropriate treatment are critical for improving survival rates in pediatric cryptococcal meningitis.

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