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Acute Cryptococcal Meningitis in a Patient With Idiopathic CD4 Lymphocytopenia: A Rare Clinical Entity
Vaishnavi Kavirayani1, Arundhati Negi1, M Mukhyaprana Prabhu1
1Internal Medicine, Kasturba Medical College, Manipal, IND.
Abstract:
Cryptococcal meningitis is a known cause of opportunistic infection in immunocompromised patients, especially those with AIDS. Very few cases exist in literature where cryptococcal meningitis is seen in patients without evidence of HIV infection. Here, we describe a case of an elderly woman presenting with clinical features of meningitis. Our patient tested positive for cryptococcal antigen (CRAg) in the CSF and growth of Cryptococcus neoformans was obtained in CSF culture. Further laboratory investigations revealed CD4 lymphocytopenia (233 cells/μl) in the absence of HIV infection. When we checked the CD4 count, beyond a period of six weeks, it was reported to be low, which confirmed our diagnosis of idiopathic CD4 lymphocytopenia (ICL). She was successfully treated with amphotericin B along with flucytosine for two weeks and discharged on maintenance antifungal therapy for eight weeks. This case emphasizes the need to maintain a high index of suspicion and consider the possibility of opportunistic infections even in the absence of HIV infection for timely diagnosis and treatment.
Insights
Cryptococcal meningitis can occur in patients without HIV, presenting as an opportunistic infection. This case highlights idiopathic CD4 lymphocytopenia as a cause, emphasizing the need for high suspicion in non-HIV patients.
Area of Science:
- Infectious Diseases
- Immunology
Background:
- Cryptococcal meningitis is a significant opportunistic infection primarily affecting individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Cases of cryptococcal meningitis in non-HIV-infected individuals are rare, posing diagnostic challenges.
Observation:
- An elderly woman presented with symptoms suggestive of meningitis.
- Cerebrospinal fluid (CSF) analysis revealed positive cryptococcal antigen (CRAg) and growth of *Cryptococcus neoformans*.
- Laboratory tests showed CD4 lymphocytopenia (233 cells/μl) without evidence of HIV infection, later confirmed as idiopathic CD4 lymphocytopenia (ICL).
Findings:
- The patient was diagnosed with cryptococcal meningitis secondary to idiopathic CD4 lymphocytopenia.
- Successful treatment involved amphotericin B and flucytosine, followed by maintenance antifungal therapy.
Implications:
- This case underscores the importance of considering opportunistic infections, such as cryptococcal meningitis, in patients presenting with meningitis symptoms, even in the absence of HIV.
- Maintaining a high index of suspicion for conditions like idiopathic CD4 lymphocytopenia is crucial for prompt diagnosis and effective management of cryptococcal meningitis in non-HIV-infected individuals.
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