SHM Converge Scientific Abstract ePoster Gallery-Concurrent Cryptococcal and Tuberculosis Meningitis in an Immunocompromised Adult

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This case report describes a rare and life-threatening co-infection of cryptococcal meningitis (CM) and tuberculosis meningitis (TBM) in a 33-year-old immunocompromised Kenyan man with liver cirrhosis and portal hypertension. He presented with 3 days of worsening headache, fever, nausea, vomiting, confusion, and meningeal signs. Cerebrospinal fluid showed markedly low glucose and high protein, with positive India ink and cryptococcal antigen testing, and PCR positive for Mycobacterium tuberculosis; culture grew Cryptococcus species. HIV testing was negative.<br /><br />He was treated with amphotericin B, fluconazole, dexamethasone, and standard anti-tuberculosis therapy, along with a therapeutic lumbar puncture. His hospital course was complicated by sensorineural hearing loss.<br /><br />The authors emphasize that concurrent CM and TBM, though rare, should be considered in immunocompromised patients, including those with cirrhosis. They note that cirrhosis increases susceptibility to disseminated cryptococcosis, and this may be the first reported case of CM/TBM co-infection in a cirrhotic patient. They also highlight uncertainty about the role of adjunctive corticosteroids in non-HIV patients with this dual infection, since steroids are recommended for TBM but have shown harm in HIV-associated cryptococcal meningitis.<br /><br />Overall, the report calls for greater awareness of this co-infection and further research on steroid use in non-HIV populations with concurrent TBM and CM.

Asset Subtitle

Keir MacKay

Meta Tag

Author List Caitrin Kelly, Hassan Abdi, Ian Molenje, Keir MacKay, Maureen Bikoro

Category Clinical Vignettes

Concept Cryptococcal Meningitis

Concept Tuberculous Meningitis

Concept Meningitis

Concept Cryptococcosis

Concept Tuberculosis

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester

Presenting Author Keir MacKay

Track Adult

Keywords

cryptococcal meningitis

tuberculosis meningitis

co-infection

immunocompromised

liver cirrhosis

portal hypertension

cerebrospinal fluid

cryptococcus species

Mycobacterium tuberculosis

sensorineural hearing loss

Cryptococcal Meningitis

Tuberculous Meningitis

Meningitis

Cryptococcosis

Tuberculosis