Cryptococcus neoformans Meningitis in a Patient With Epidermolysis Bullosa and Rheumatoid Arthritis

Cryptococcal meningitis (CM) is an opportunistic fungal infection with a high mortality rate commonly associated with those with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The epidemiology of CM in HIV-negative individuals is unclear, although it is estimated to be increasing in developed countries. We present a case of Cryptococcus neoformans meningitis in a 59-year-old HIV-negative female taking long-term mycophenolate (MMF) for epidermolysis bullosa acquisita (EBA) and upadacitinib for rheumatoid arthritis (RA). With an aggressive antifungal regimen, therapeutic lumbar punctures, lumbar drain insertion, and ventriculoperitoneal shunt insertion, the patient's condition improved, and she was discharged from the hospital.