Case 334: Cryptococcal Meningitis

Area of Science:

• Neurology
• Obstetrics
• Infectious Diseases

Background:

• A 30-year-old pregnant patient (25 weeks) presented with a month of headache and two weeks of somnolence, photophobia, diplopia, and neck pain.
• Initial presentation included papilledema and right abducens nerve palsy, with a normal head CT scan.
• Pregnancy was uncomplicated, and the patient denied fever, recent travel, or relevant medical history.

Purpose of the Study:

• To investigate the cause of progressive neurological symptoms in a pregnant patient.
• To differentiate between infectious, inflammatory, and other neurological etiologies.

Main Methods:

• Clinical examination, including cranial nerve assessment and fundoscopy.
• Cranial CT and MRI of the brain.
• Lumbar puncture for cerebrospinal fluid (CSF) analysis.
• Extensive serologic and microbiologic testing.

Main Results:

• Brain MRI revealed infratentorial and supratentorial abnormalities.
• Lumbar puncture showed elevated CSF opening pressure (32 cm H2O) and lymphocytic pleocytosis (136 ×10^6/L total nucleated cells, 59% lymphocytes).
• Extensive workup for infectious agents (including mycobacteria, viruses, and fungi) and autoimmune conditions was negative.

Conclusions:

• The patient's presentation and diagnostic findings are suggestive of an inflammatory or infectious neurological process, despite negative specific testing.
• Further investigation and management are warranted to determine the underlying cause and ensure maternal and fetal well-being.