Jacobs Journal of Clinical Case Reports

Cryptococcal Meningitis in the Immunocompetent Host: A Case Report and Review of the Literature

*Caitlin Gibson
Department Of Case Reports, University Of North Texas System College Of Pharm, United States

*Corresponding Author:
Caitlin Gibson
Department Of Case Reports, University Of North Texas System College Of Pharm, United States
Email:Caitlin.gibson@unthsc.edu

Published on: 2016-05-18

Abstract

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.

Keywords

Amphotericin B; Antifungal Therapy; Cryptococcosis; Cryptococcal Meningitis; Immunocompetent; Meningitis

Introduction

Immuncompromised hosts, including those with HIV, transplants, and malignancies, have an increased risk of acquiring cryptococcal meningitis [CM][1]. Factors associated with cryptococcal infection in HIV(-) patients include immunosuppressive drug therapy, diabetes mellitus, chronic renal failure, liver failure or cirrhosis, Cushing’s syndrome, sarcoidosis, and lupus erythematous[2-7]. However, 17-33% of patients with cryptococcosis have no identifiable immune dysfunction[2,6,8]. Sparse published data on risk factors and management of these patients exists. In this article we discuss differences in clinical presentation, diagnosis, treatment, and outcomes of CM in immunocompetent versus immunocompromised patients.