Post-endoscopic neurosurgical Candida albicans meningoencephalitis diagnosed by targeted next-generation sequencing:...

Candida albicans (C. albicans) meningoencephalitis is a rare but diagnostically challenging infection that usually occurs in immunocompromised individuals, although life-threatening disease can also develop in immunocompetent patients. The absence of specific clinical features and the limited sensitivity of conventional microbiological methods frequently lead to diagnostic delays. We describe a 79-year-old woman with no known immunodeficiency who presented with symptoms initially suggestive of bacterial meningitis and failed to improve after empirical ceftriaxone, meropenem, and vancomycin therapy, while repeated blood and cerebrospinal fluid (CSF) cultures remained negative. Her history of endoscopic transsphenoidal surgery raised concern for an atypical postoperative infection. Targeted next-generation sequencing (tNGS) of the CSF subsequently provided important etiological evidence for C. albicans and supported timely initiation of amphotericin B deoxycholate and flucytosine, followed by oral fluconazole, resulting in marked clinical and biochemical improvement. This case highlights the diagnostic difficulty of intracranial Candida infection. In this patient, CSF tNGS provided important etiological evidence when routine microbiological tests remained negative and contributed to timely targeted antifungal treatment.