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Non-acquired immunodeficiency syndrome-related cryptococcal meningitis with recurrent acute stroke: A case report

Bijun Ye1, Jian Wu1, Yinhong Qiu1

  • 1Department of Neurology, Tiantai County People's Hospital, China.

The Journal of International Medical Research
|June 24, 2025
PubMed

Insights

This case report details a fatal cryptococcal meningitis (CM) in an HIV-negative patient presenting with recurrent stroke. Early cryptococcal antigen testing is crucial for diagnosing non-AIDS-related CM, especially with neurological symptoms.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Medical Case Reports

Background:

  • Cryptococcal meningitis (CM) is typically linked to human immunodeficiency virus (HIV) infection.
  • Recurrent acute stroke is an unusual initial presentation for intracranial infections.
  • Non-acquired immunodeficiency syndrome (non-AIDS)-related CM cases are infrequently reported, particularly with stroke manifestations.

Purpose of the Study:

  • To report a rare case of cryptococcal meningitis presenting as recurrent acute stroke in an HIV-negative patient.
  • To highlight the diagnostic challenges and potential pitfalls in managing non-AIDS-related CM.
  • To emphasize the importance of early diagnostic methods for cryptococcal infections.

Main Methods:

  • A comprehensive diagnostic workup including lung and cranial imaging (CT, MRI).
  • Cerebrospinal fluid (CSF) examination for pathogen identification.
  • Clinical observation of patient's response to treatment.

Main Results:

  • The patient, negative for HIV, developed recurrent stroke followed by meningitis symptoms.
  • Diagnosis of cryptococcal meningitis was confirmed via imaging and CSF analysis.
  • Aggressive treatment with amphotericin B and flucytosine led to complications including respiratory failure, hepatic and renal insufficiency, and infectious shock, ultimately resulting in death.

Conclusions:

  • Clinicians must consider cryptococcal meningitis in patients with meningitis imaging findings, even without HIV.
  • Prompt cryptococcal capsular antigen testing is recommended as a sensitive screening tool.
  • This case underscores the need for heightened awareness and timely diagnosis of non-AIDS-related CM to improve patient outcomes.
Keywords:
Cryptococcal meningitisacutecase reportcerebral strokehuman immunodeficiency virus-negative

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