Cryptococcal Meningitis in the Immunocompetent Host: A Case Report and Review of the Literature
Published on: 2016-05-18
A 79-year-old previously healthy male presented to the emergency department with a three-month history of headaches, falls, and personality changes. No acute changes were evident upon computed tomography scan of the head. Blood cultures grew yeast, and the patient was treated empirically for candidemia with fluconazole. The cultures were finalized seven days later, revealing Cryptococcus neoformans. A nucleated cell count of 97 cells/μL was found on lumbar puncture. The patient was diagnosed with CM and treated with amphotericin B + flucytosine. His hospital stay was complicated by several transfers to the intensive care unit, severe hypokalemia, anemia requiring multiple blood transfusions, methicillin-resistant Staphyloccocus aureus septic arthritis and bacteremia, possible endocarditis, vancomycin-resistant Enterococcus bacteremia, health care-associated pneumonia, and Clostridium difficile colitis. Four months later, he was discharged to a long-term care facility. CM is commonly diagnosed in immunocompromised patients, but infection of patients with no obvious immune deficits is rare. Compared to immunocompromised patients, immunocompetent hosts often suffer worse outcomes of infection due to delays in diagnosis and less robust response to treatment. Here we present a case report and review of the available literature regarding treatment of CM in an immunocompetent host. Prompt diagnosis and aggressive treatment is key for optimal outcomes.