# Cryptococcus neoformans Meningitis in a Patient With Epidermolysis Bullosa and Rheumatoid Arthritis

## TL;DR

A 59-year-old HIV-negative woman with two autoimmune conditions developed Cryptococcus neoformans meningitis and was successfully treated with a combination of antifungal therapy and surgical interventions.

## Contribution

This case highlights the rare occurrence of cryptococcal meningitis in an HIV-negative patient with autoimmune disorders and immunosuppressive therapy.

## Key findings

- Cryptococcus neoformans meningitis can occur in HIV-negative individuals on immunosuppressive drugs.
- Aggressive antifungal treatment and neurosurgical interventions led to clinical improvement in the patient.

## Abstract

Cryptococcal meningitis (CM) is an opportunistic fungal infection with a high mortality rate commonly associated with those with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The epidemiology of CM in HIV-negative individuals is unclear, although it is estimated to be increasing in developed countries. We present a case of Cryptococcus neoformans meningitis in a 59-year-old HIV-negative female taking long-term mycophenolate (MMF) for epidermolysis bullosa acquisita (EBA) and upadacitinib for rheumatoid arthritis (RA). With an aggressive antifungal regimen, therapeutic lumbar punctures, lumbar drain insertion, and ventriculoperitoneal shunt insertion, the patient's condition improved, and she was discharged from the hospital.