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A rare presentation of cryptococcal meningoencephalitis in an immunocompetent individual

Ashwin Malhotra, Qin Rao, Sean Kelly, Danielle Schwartz, Robert Chow
  • Ashwin Malhotra
    Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Center; Department of Medicine, Stony Brook University Hospital, New York, NY, United States | asm9059@nyp.org
  • Qin Rao
    Department of Medicine, Stony Brook University Hospital, New York, NY, United States
  • Sean Kelly
    Stony Brook University School of Medicine, Stony Brook University, New York, NY, United States
  • Danielle Schwartz
    Department of Medicine, Stony Brook University Hospital, New York, NY, United States
  • Robert Chow
    Department of Infectious Disease, Stony Brook University Hospital, New York, NY, United States

Abstract

Cryptococcal meningoencephalitis is a leading of morbidity and mortality in immunocompromised individuals worldwide. However, there are few documented cases in immunocompetent patients. We present a rare case of disseminated Cryptococcus with progression to meningoencephalitis in an immunocompetent patient, with a possible atypical presentation. Magnetic resonance imaging of the brain and electroencephalogram to rule out brain metastasis were negative. Lumbar puncture resulted positive for Cryptococcus neoformans antigen at titers of 1:2048 and a detailed history later revealed occupational exposure to bird dander by cleaning floors and cages. Diagnosis is challenging, with delays often resulting in increased morbidity and mortality. Cerebrospinal fluid and serum Cryptococcus antigen play a key role in both diagnosis and determining treatment efficacy. Furthermore, current treatment guidelines are used for immunocompromised individuals. Due to the significant side effects of these medications, further research is needed to determine the optimal treatment duration for immunocompetent patients to minimize the need for unnecessary therapy.

Keywords

Altered mental status; cryptococcal meningoencephalitis; lumbar puncture.

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Submitted: 2017-07-08 05:09:37
Published: 2017-09-15 17:43:40
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Copyright (c) 2017 Ashwin Malhotra, Qin Rao, Sean Kelly, Danielle Schwartz, Robert Chow

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