Cryptococcal Meningoencephalitis in an Immunocompetent Patient: A Case Report

Cryptococcal meningoencephalitis (CM) is an infection of the brain and spinal cord caused by Cryptococcus species, an opportunistic fungus. Immunocompetent patients who present with subtle or nonspecific symptoms may experience a delayed diagnosis of CM. We present a case of a 25-year-old immunocompetent woman who arrived with severe headache, fever, and mild meningeal symptoms. Initial infectious and imaging studies were unrevealing, and lumbar puncture revealed an elevated opening pressure with normal cerebrospinal fluid indices. Despite lacking conventional risk factors, she was found to have a positive Cryptococcus antigen in serum on two repeated tests. Her workup did not identify an underlying immunodeficiency. A later careful re-evaluation of the history revealed that she had exposure to backyard poultry. She improved gradually with antifungal therapy and was discharged on long-term fluconazole. This case illustrates the diagnostic complexity of CM in patients without overt immunosuppression and emphasizes the importance of considering fungal meningitis in the differential diagnosis of persistent or atypical headaches. Increased awareness of these presentations is critical, as timely recognition and early antifungal treatment remain essential to reducing morbidity and preventing neurologic complications.