SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Cryptococcal Meningitis in an Immunocompetent Host

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This case describes a 32-year-old HIV-negative man who developed cryptococcal meningitis and cryptococcal pneumonitis despite appearing immunocompetent. He presented with headaches, dizziness, blurry vision, nausea, and vomiting, after a prior outside-hospital diagnosis of cryptococcal disease with a shortened treatment course. Imaging at the current hospital showed recurrent cryptococcal infection with multiple ring-enhancing cryptococcomas in both supra- and infratentorial regions, vasogenic edema, and mild mass effect. Lumbar puncture revealed elevated opening pressure and positive cryptococcal antigen.<br /><br />Although cryptococcal meningitis is classically associated with advanced immunosuppression, it can rarely occur in immunocompetent patients and may present with nonspecific neurologic symptoms. This makes it important to search for hidden immune defects, since finding an underlying immunodeficiency can change treatment duration and prognosis. In immunocompromised patients, induction therapy is typically prolonged for 4–6 weeks, and treatment may need to be extended further after prior failure.<br /><br />The patient had no history of steroid use, solid organ transplant, chronic kidney or liver disease, or known malignancy. His CD4 count was normal, and early immunology testing has been negative. Because a subset of HIV-negative patients with cryptococcal meningitis have no obvious cause but may have rare immune disorders such as idiopathic CD4 lymphopenia, GM-CSF autoantibodies, Job syndrome, or interferon-gamma autoantibodies, a full immunodeficiency evaluation was pursued.<br /><br />The infectious disease team recommended 6 weeks of amphotericin B plus flucytosine followed by 6 weeks of fluconazole due to recurrent disease and concern for treatment failure. This case highlights that even “immunocompetent” patients with opportunistic infections require careful immunologic work-up to guide therapy and prevent complications.

Asset Subtitle

Christopher Boldt

Meta Tag

Author List Ahmed Alderazi, Christopher Boldt, Jane Buell, Lauren Rash, Thaddeus May

Category Clinical Vignettes

Concept Cryptococcal Meningitis

Concept Immunodeficiency Work-up

Concept Occult Immunodeficiency

Concept Immune Status

Concept Immunocompetent Adult

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Christopher Boldt

Track Adult

Keywords

cryptococcal meningitis

cryptococcal pneumonitis

immunocompetent

HIV-negative

cryptococcomas

amphotericin B

flucytosine

fluconazole

immunodeficiency evaluation

opportunistic infection

Cryptococcal Meningitis

Immunodeficiency Work-up

Occult Immunodeficiency

Immune Status

Immunocompetent Adult