[Neuromeningeal cryptoccosis in an HIV-negative patient in Bamako, Mali]

Neuromeningeal cryptococcosis (NMC) is a common fungal infection in immunocompromised patients with HIV infection. Its rarity outside HIV/AIDS requires a systematic search for other immunosuppressive factors and a differential diagnosis. We report a case of NMC in an immunocompetent patient admitted to the Point G University Hospital Center in Bamako, Mali.

The patient presented with fever (39.3°C), general deterioration, Glasgow Coma Scale score of 10/15 without motor deficits, neck stiffness, and helmet-like headache unresponsive to analgesics. The patient had a CD4 count of 932 cells/mm³. No other immunosuppressive conditions were noted. The diagnosis of NMC was confirmed based on clinical and microbiologic findings. The patient was successfully treated in Bamako using an alternative protocol with fluconazole, a more accessible, less expensive treatment with fewer side effects compared to amphotericin B.

The occurrence of cryptococcosis in an immunocompetent host is rare. However, it can occur in the absence of predisposing factors. Fluconazole is an effective alternative therapy.