Cryptococcal Meningitis in an HIV-Negative, Lymphoma Survivor: A Case Report of an Uncommon Dual Pathology

Cryptococcal meningitis, though uncommon, can present in individuals with compromised immunity, including those without HIV but with a history of immunosuppressive treatments. We describe the case of a 74-year-old woman with a prior diagnosis of non-Hodgkin lymphoma in remission who developed cryptococcal meningitis following a recent right insular cerebral infarct. She also exhibited a left abducent nerve palsy, raising concern for elevated intracranial pressure. Diagnostic workup revealed a cerebrospinal fluid cryptococcal antigen titre of 1:2650 and positive polymerase chain reaction (PCR) for Cryptococcus neoformans, confirming the infection. Her clinical course was further complicated by anthracycline-induced cardiomyopathy and pulmonary embolism. The patient was treated with liposomal amphotericin B and fluconazole, followed by the addition of flucytosine, which led to microbiological clearance, resolution of the cranial nerve palsy, and overall clinical improvement. This case highlights the need for timely cerebrospinal fluid (CSF) analysis and a multidisciplinary approach when evaluating unexplained neurological symptoms in patients with prior oncologic treatment.