# A Case of Cryptococcal Meningitis in an Immunocompetent Individual

## TL;DR

A 49-year-old immunocompetent man was diagnosed with cryptococcal meningitis after initial misinterpretation of his symptoms and imaging.

## Contribution

This case highlights the diagnostic challenges of cryptococcal meningitis in immunocompetent individuals and the need for heightened suspicion.

## Key findings

- Cryptococcal meningitis was confirmed via cerebrospinal fluid evaluation despite initial imaging suggesting a cerebrovascular accident.
- The patient's symptoms improved with antifungal therapy and intracranial pressure management.
- The case emphasizes the importance of considering fungal meningitis in non-immunocompromised patients.

## Abstract

Cryptococcal meningitis is classically associated with immunocompromised hosts but can also occur in individuals without identifiable immune dysfunction. Its nonspecific and often indolent presentation may delay diagnosis, particularly when early neuroimaging suggests alternative etiologies. We report a case of a 49-year-old immunocompetent man who presented with progressive headaches, sensory changes such as transient hearing loss, visual changes, and balance issues. Initial imaging showed a hyperdense area on CT, which was interpreted as a possible cerebrovascular accident, delaying recognition of an infectious process. Cerebrospinal fluid (CSF) evaluation ultimately confirmed cryptococcal meningitis, and the patient improved with targeted antifungal therapy and intracranial pressure (ICP)-directed management. This case highlights diagnostic challenges in immunocompetent hosts and underscores the importance of maintaining suspicion for fungal meningitis even without classic risk factors.