Normal opening pressure lumbar puncture in cryptococcal meningitis complicated by a cerebral venous thrombosis: a case report and literature review

TL;DR

This paper reports a rare case of cryptococcal meningitis with normal opening pressure and cerebral venous thrombosis in an immunocompetent patient.

Contribution

It highlights the diagnostic challenges of CM with normal opening pressure and CVT in non-HIV individuals.

Findings

A case of CM with CVT was diagnosed in an immunocompetent patient.

Normal opening pressure during lumbar puncture complicated the diagnosis.

The report discusses pathophysiology and diagnostic challenges.

Abstract

Cryptococcal meningitis (CM) is a severe fungal infection that primarily affects individuals with compromised immune systems, such as those living with HIV/AIDS or undergoing immunosuppressive therapy. Elevated intracranial pressure is a common complication of CM and remains an important diagnostic parameter in patients with CM. This report describes a case of CM complicated with cerebral venous thrombosis (CVT) in an immunocompetent patient residing in the southern region of Peninsular Malaysia. The diagnosis of CM was confirmed by cerebrospinal fluid (CSF) culture; however, the patient presented with normal opening pressure during lumbar puncture. The pathophysiology and factors of causality, together with their diagnostic challenges, are discussed.