Cryptococcal Meningitis in an Immunocompetent Patient With Underlying Risk Factors

TL;DR

A young, immunocompetent man with a history of drug abuse and hepatitis C developed cryptococcal meningitis, requiring multiple treatment phases and surgical interventions.

Contribution

Highlights the rare occurrence of cryptococcal meningitis in an immunocompetent individual with atypical risk factors.

Findings

Cryptococcal meningitis occurred in an immunocompetent patient with intravenous drug abuse and hepatitis C.

Shorter induction therapy was initially effective but required re-initiation due to new neurological symptoms.

The patient needed multiple surgical interventions for persistent intracranial pressure.

Abstract

Cryptococcal meningitis, a severe fungal infection of the central nervous system, is usually found in immunocompromised patients, especially those with human immunodeficiency virus/acquired immunodeficiency syndrome. Its occurrence in immunocompetent individuals is rare and the presentation can be nonspecific. We present a case of cryptococcal meningitis in a young, immunocompetent male with a known history of intravenous drug abuse who was also found to have hepatitis C during admission. Induction therapy with amphotericin B and flucytosine was completed for 14 days. This shorter duration was considered as he had a good clinical response with rapid improvement in mental status and intracranial pressure with an extraventricular drain and negative repeat cerebrospinal fluid (CSF) culture. However, during the consolidation phase with fluconazole, the patient developed new neurologic symptoms and the induction phase had to be re-initiated for a total of 28 days. The patient likewise required the re-placement of an extraventricular drain and the creation of a ventriculoperitoneal shunt due to persistent CSF accumulation and increased intracranial pressure. He was eventually discharged on fluconazole for a planned consolidation phase of eight weeks, followed by a prolonged maintenance phase, but the patient was lost to follow-up.

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