SHM Converge Scientific Abstract ePoster Gallery-Severe Sars-Cov-2 (Covid-19) Presenting as Cryptococcal Meningitis With Thromboembolism: A Fatal Outcome

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This case report describes a 54-year-old woman with multiple chronic conditions, including MGUS, who initially developed severe COVID-19 pneumonia complicated by hypoxic respiratory failure, deep vein thrombosis, and pulmonary emboli. She was treated with remdesivir, dexamethasone, heparin, and later apixaban.<br /><br />Two weeks after discharge, she returned with severe headache, vomiting, gait instability, transient vision loss, and worsening confusion. Brain MRI showed multiple embolic infarcts, with new ischemic strokes on repeat imaging, along with mild hydrocephalus and diffuse cerebral edema. EEG findings suggested diffuse cerebral dysfunction. Because of persistent encephalopathy, lumbar puncture was performed and revealed markedly elevated opening pressure, high protein, low glucose, and yeast on culture consistent with Cryptococcus neoformans. She was started on amphotericin B, but flucytosine was unavailable, prompting transfer to a tertiary center.<br /><br />After transfer, her neurologic status rapidly deteriorated. She developed fixed dilated pupils, required intubation, and imaging showed tonsillar herniation from increased intracranial pressure. Neurosurgery placed an external ventricular drain for decompression, but repeat studies continued to show cryptococcal infection and worsening cerebral edema. Despite aggressive treatment, her condition progressed to herniation, hemorrhage, and severe hypernatremia. After discussion with her family, she was transitioned to comfort care and died several days later.<br /><br />The authors emphasize that severe COVID-19 can be associated with thromboembolism and that immunosuppression from the disease and steroid treatment may increase susceptibility to opportunistic infections such as cryptococcal meningitis. They highlight the importance of considering secondary infections when symptoms persist or worsen despite standard COVID-19 therapy, as delayed diagnosis and limited access to antifungal treatment can lead to fatal outcomes.

Asset Subtitle

Monica Singh

Meta Tag

Author List Demetrio J. Agcaoili, Faraz Alam, Hassan Barazi, Milind Awale, Monica Singh, Rami Ausi, Sneha Jacob

Category Clinical Vignettes

Concept Severe COVID-19

Concept Cryptococcal Meningitis

Concept Ischemic Stroke

Concept Deep Vein Thrombosis

Concept Pulmonary Embolism

Distinguished Non-Finalist

Presenter Organization WVU Medicine Wheeling Hospital

Presenting Author Monica Singh

Track Adult

Keywords

COVID-19 pneumonia

cryptococcal meningitis

Cryptococcus neoformans

ischemic stroke

thromboembolism

deep vein thrombosis

pulmonary embolism

intracranial pressure

cerebral edema

immunosuppression

Severe COVID-19

Cryptococcal Meningitis

Ischemic Stroke

Deep Vein Thrombosis

Pulmonary Embolism