# Cryptococcal Meningoencephalitis With Herpes Zoster Coinfection in a Retrovirus-Positive Adolescent Male With a Normal CD4 Count: A Rare Case

## TL;DR

A rare case of cryptococcal meningoencephalitis combined with herpes zoster is reported in an HIV-positive adolescent with normal immune function.

## Contribution

The novelty lies in the rare co-occurrence of cryptococcal meningoencephalitis and herpes zoster in an HIV-positive patient with a normal CD4 count.

## Key findings

- Cryptococcal meningoencephalitis typically affects immunocompromised individuals but occurred in a patient with normal CD4 levels.
- The case highlights the complexity of managing coinfections in HIV-positive patients.
- This rare combination may complicate diagnosis and treatment outcomes.

## Abstract

Cryptococcal meningoencephalitis is a grave and lethal form of an opportunistic infection usually occurring in immunocompromised patients (i.e., those with AIDS, organ transplant recipients, or those on immunosuppressive therapy) caused by Cryptococcus species, namely Cryptococcus neoformans, which has a worldwide distribution, or Cryptococcus gattii, which is predominantly found in tropical, subtropical, and temperate regions. Cryptococcus species are usually found in soil contaminated with bird or animal droppings in the form of cryptococcal spores. The former occurs predominantly in immunocompromised patients, affecting the central nervous system (CNS), while the latter occurs in immunocompetent patients, affecting the pulmonary system predominantly. Transmission occurs through these spores, which subsequently disseminate to the CNS through the hematogenous route. Manifestations include fever, headache, nausea, altered mental status, and meningismus in certain cases, potentially advancing to neurological problems such as elevated intracranial pressure, blindness, and seizures. Presentation in immunocompetent individuals is indolent, so diagnosis and treatment are delayed. Timely diagnosis and immediate treatment are essential to avert complications and mortality. Over the past few years, cryptococcal infection has seen an upward trend globally. Despite the availability of antifungal therapy, it has emerged as a significant public health concern, rendering it a therapeutically challenging case. Moreover, infrequent coinfections with bacteria or viruses might complicate therapy and prognosis. We hereby report a rare case of cryptococcal meningoencephalitis with herpes zoster coinfection occurring in an HIV patient with a normal CD4 count.