Cryptococcal Meningitis Beyond Immunosuppression: A Case Report in an Immunocompetent Individual

Area of Science:

• Infectious Diseases
• Neurology
• Mycology

Background:

• Cryptococcal meningitis is a severe fungal infection typically seen in immunocompromised individuals.
• It is increasingly diagnosed in immunocompetent hosts.
• Overlapping symptoms with tuberculous meningitis can delay diagnosis in endemic regions.

Purpose of the Study:

• To highlight the diagnostic challenges of cryptococcal meningitis in immunocompetent patients.
• To emphasize the importance of early mycological investigation.
• To underscore the need for considering cryptococcal meningitis in chronic meningitis cases.

Main Methods:

• Case presentation of a 44-year-old immunocompetent woman with chronic meningitis.
• Initial diagnosis was presumptive tuberculous meningitis based on CSF findings and clinical presentation.
• Diagnosis was confirmed by India ink staining and fungal culture of CSF after lack of response to antituberculous therapy.

Main Results:

• The patient, an immunocompetent woman, presented with symptoms mimicking tuberculous meningitis.
• Cerebrospinal fluid analysis showed hypoglycorrhachia, elevated protein, and lymphocytic pleocytosis.
• Cryptococcus neoformans was confirmed via India ink staining and fungal culture, leading to appropriate antifungal treatment and recovery.

Conclusions:

• Cryptococcal meningitis should be considered in immunocompetent patients with chronic meningitis, even without typical risk factors.
• Early mycological investigation is vital to prevent diagnostic delays, especially when tuberculosis is suspected but not confirmed.
• Prompt diagnosis and treatment of cryptococcal meningitis improve patient outcomes.