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Symptomatic Cryptococcal Meningitis with Negative Serum and Cerebrospinal Fluid Cryptococcal Antigen Tests
Vivien Nanfuka1, Mkhoi L Mkhoi2,3,4, Jane Gakuru2
1Infectious Diseases Unit, Kiruddu National Referral Hospital, Kampala, Uganda.
HIV/AIDS (Auckland, N.Z.)
|September 13, 2021
Summary
Cryptococcal meningitis can occur even with negative antigen tests, especially in HIV patients with low fungal burden. This case highlights rare scenarios in cryptococcal meningitis diagnosis and management.
Area of Science:
- Infectious Diseases
- Neuroscience
- Immunology
Background:
- Cryptococcal meningitis is a major cause of mortality in advanced HIV disease.
- Diagnosis typically relies on positive cerebrospinal fluid cryptococcal antigen (CrAg) tests.
- This case presents a diagnostic challenge with negative CrAg despite symptoms.
Observation:
- A 56-year-old HIV-positive woman presented with cryptococcal meningitis symptoms.
- Serum and cerebrospinal fluid CrAg tests were negative.
- Cerebrospinal fluid India ink and quantitative culture were positive for Cryptococcus spp.
Findings:
- The patient received intravenous amphotericin B, oral flucytosine, and fluconazole.
- She improved symptomatically, with negative CSF cultures by day 7.
- This highlights the possibility of negative CrAg tests with low fungal burden.
Implications:
- Clinicians should consider cryptococcal meningitis despite negative CrAg tests, especially with low fungal burden.
- The case underscores that cryptococcal meningitis can occur in patients with high CD4 counts.
- It also points to potential early seroconversion and symptomatic relapse with negative serum CrAg.
