Cryptococcal Meningitis in an Immunocompetent Patient With Underlying Risk Factors

Cryptococcal meningitis, a severe fungal infection of the central nervous system, is usually found in immunocompromised patients, especially those with human immunodeficiency virus/acquired immunodeficiency syndrome. Its occurrence in immunocompetent individuals is rare and the presentation can be n...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-07, Vol.16 (7), p.e64387
Main Authors: Untalan, Axle D, Chinchanikar, Suyash, Arty, Fnu, Khan, Mahrukh A, Shah, Shazia M
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Antigens
Blood
Catheters
Drug abuse
Drug use
Edema
Endocarditis
Fungal infections
Hepatitis C
HIV
Human immunodeficiency virus
Immune system
Immunocompetence
Immunoglobulins
Induction therapy
Infectious diseases
Leukocytes
Medical imaging
Meningitis
Mortality
Neurosurgery
Neutrophils
Patients
Risk factors
Substance abuse treatment
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Summary:Cryptococcal meningitis, a severe fungal infection of the central nervous system, is usually found in immunocompromised patients, especially those with human immunodeficiency virus/acquired immunodeficiency syndrome. Its occurrence in immunocompetent individuals is rare and the presentation can be nonspecific. We present a case of cryptococcal meningitis in a young, immunocompetent male with a known history of intravenous drug abuse who was also found to have hepatitis C during admission. Induction therapy with amphotericin B and flucytosine was completed for 14 days. This shorter duration was considered as he had a good clinical response with rapid improvement in mental status and intracranial pressure with an extraventricular drain and negative repeat cerebrospinal fluid (CSF) culture. However, during the consolidation phase with fluconazole, the patient developed new neurologic symptoms and the induction phase had to be re-initiated for a total of 28 days. The patient likewise required the re-placement of an extraventricular drain and the creation of a ventriculoperitoneal shunt due to persistent CSF accumulation and increased intracranial pressure. He was eventually discharged on fluconazole for a planned consolidation phase of eight weeks, followed by a prolonged maintenance phase, but the patient was lost to follow-up.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.64387