SHM Converge Scientific Abstract ePoster Gallery-Cryptcoccus Gattii Infection in an Immunocompetent Patient: A Diagnostic and Therapeutic Challenge

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This case describes a 59-year-old immunocompetent woman with a 1-month history of persistent migraine-like headaches, followed by nausea, vomiting, and later a syncopal episode with seizure-like activity. Initial CT imaging and routine laboratory studies were unrevealing, though MRI of the brain showed hyperintense periventricular and subcortical white matter lesions. Because of ongoing symptoms, further evaluation was performed.<br /><br />Lumbar puncture revealed markedly elevated intracranial pressure, very low CSF glucose, and high protein. Serum cryptococcal antigen was strongly positive, and CSF culture confirmed Cryptococcus gattii. Additional testing for HIV, autoimmune disease, and other infectious causes was negative, supporting infection in an otherwise immunocompetent host. Chest CT later identified a left lower lobe lung mass with mediastinal and hilar lymphadenopathy, and biopsy confirmed fungal organisms consistent with Cryptococcus, suggesting a pulmonary source with CNS dissemination.<br /><br />The patient was treated with induction therapy using intravenous liposomal amphotericin B and oral flucytosine. Over the course of treatment, cryptococcal antigen titers declined and repeat CSF cultures became negative, although serial brain MRI showed persistent/enlarging lesions concerning for cryptococcomas. Her course was complicated by ongoing headaches, diplopia, and persistent elevated intracranial pressure, requiring multiple lumbar punctures and eventual ventriculoperitoneal shunt placement. She was discharged to complete consolidation and long-term maintenance therapy with fluconazole.<br /><br />This case highlights that C. gattii can cause severe pulmonary and central nervous system disease even in immunocompetent patients. Because symptoms and imaging can be nonspecific—and CT may be negative early—clinicians must maintain a high index of suspicion to ensure timely diagnosis and treatment.

Asset Subtitle

Andrea Rodriguez Jimenez

Meta Tag

Author List Andrea Rodriguez Jimenez, Carlos J. Ramirez Matos, Imad Dibo, Zein Barakat, Zoya Khan

Category Clinical Vignettes

Concept Cryptococcus gattii

Concept Cryptococcosis

Concept Amphotericin B

Concept Cryptococcal Antigen

Concept Disseminated Cryptococcosis

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Andrea Rodriguez Jimenez

Track Adult

Keywords

Cryptococcus gattii

immunocompetent host

cryptococcal meningitis

intracranial pressure

cryptococcoma

lumbar puncture

amphotericin B

flucytosine

fluconazole

pulmonary cryptococcosis

Cryptococcus gattii

Cryptococcosis

Amphotericin B

Cryptococcal Antigen

Disseminated Cryptococcosis