SHM Converge Scientific Abstract ePoster Gallery-Cryptococcal Meningitis in the Immunocompetent Patient: A Case Series

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This case series describes three presumed immunocompetent patients who developed new-onset or recurrent cryptococcal meningitis, a fungal infection that usually affects immunocompromised individuals such as patients with HIV/AIDS. The authors emphasize that cryptococcosis can still occur without obvious immune suppression and may present with neurologic symptoms that warrant fungal evaluation.<br /><br />The three patients were HIV-negative and had no clear risk factors identified during admission. Presentations included dizziness, altered mental status, headache, and blurry vision. Diagnostic workups showed evidence of Cryptococcus neoformans infection through cultures and elevated cryptococcal antigen levels in serum and cerebrospinal fluid. Imaging findings supported central nervous system involvement, including nodular brain enhancement, leptomeningeal enhancement, cerebral edema, optic nerve sheath enhancement, and signs of persistent infection in one recurrent case.<br /><br />One patient had a cavitary lung lesion with positive bronchoscopy cultures, another had pulmonary, liver, and spleen abnormalities along with meningitis, and the third had recurrent disease despite prior treatment, eventually requiring multiple treatment courses, craniectomy, and temporal lobectomy. The other two patients improved with antifungal therapy and were discharged.<br /><br />The report notes that prior literature on cryptococcal meningitis in immunocompetent people is sparse, and when reported, exposures such as travel, pest control work, or contact with birds or bats are often identified. This series highlights that such infections may occur even without known exposures or recognized immunodeficiency.<br /><br />The main teaching point is that cryptococcal meningitis should be considered in immunocompetent patients who present with concerning neurologic symptoms, and evaluation for invasive fungal infection should not be delayed solely because a patient lacks classic risk factors.

Asset Subtitle

Ji-Cheng Hsieh

Meta Tag

Author List Adam Zimilover, Henry Donaghy, Iffath Islam, Ji-Cheng Hsieh, Maham Ghani, Richie Chen, Samantha Sattler, Simon Kashfi

Category Clinical Vignettes

Concept Cryptococcal Meningitis

Concept Serum Cryptococcal Antigen Test

Concept Diagnostic Evaluation

Concept Immunocompetent Patient

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization Zucker School of Medicine at Hofstra University

Presenting Author Ji-Cheng Hsieh

Track Adult

Keywords

cryptococcal meningitis

Cryptococcus neoformans

immunocompetent patients

fungal infection

neurologic symptoms

central nervous system

cryptococcal antigen

HIV-negative

antifungal therapy

recurrent meningitis

Cryptococcal Meningitis

Serum Cryptococcal Antigen Test

Diagnostic Evaluation

Immunocompetent Patient

Clinical Presentation