Cryptococcal meningitis associated with hydrocephalus in an immunocompetent patient
DOI:
https://doi.org/10.23938/ASSN.1067Keywords:
Cryptococcus, Hydrocephalus, Immunocompetence, Meningitis, VentriculostomyAbstract
Cryptococcal meningitis is an infrequent infection with high morbidity and mortality. Its presentation in immunocompetent patients is rare.
We present the case of a 67-year-old male who was admitted for subacute symptoms of gait disturbance and urinary incontinence. Neurological examination revealed inability to stand and memory impairment. Cranial imaging showed obstructive tetraventricular hydrocephalus with areas of gliosis in the cerebellar peduncles. Endoscopic treatment of hydrocephalus was performed and cerebrospinal fluid samples taken revealing the growth of Cryptococcus neoformans. The patient improved with the endoscopic treatment and after completing intravenous antifungal therapy with liposomal amphotericin B and fluconazole for ten weeks.
Antifungals are used to treat cryptococcal meningitis in immunocompetent patients. On rare occasions, it presents with hydrocephalus, a situation that requires surgical treatment using cerebrospinal fluid diversions or endoscopic techniques.
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SATISHCHANDRA P, MATHEW T, GADRE G, NAGARATHNA S, CHANDRAMUKHI A, MAHADEVAN A et al. Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India 2007; 55(3): 226-232. https://doi.org/10.4103/0028-3886.35683
TEMFACK E, BOYER-CHAMMARD T, LAWRENCE D, DELLIERE S, LOYSE A, LANTERNIER F et al. New insights into Cryptococcus spp biology and cryptococcal meningitis. Curr Neurol Neurosci Rep 2019; 19: 81. https://doi.org/10.1007/s11910-019-0993-0
LIAO CH, CHI CY, WANG YJ, TSENG SW, CHOU CH, HO CM et al. Different presentations and outcomes between HIV-infected and HIV-uninfected patients with cryptococcal meningitis. J Microbiol Immunol Infect 2012; 45(4): 296-304. https://doi.org/10.1016/j.jmii.2011.12.005
SEETAHAL-MARAJ P, GIDDINGS S, RAMCHARAN K, RAMNARINE N. Obstructive hydrocephalus secondary to cryptococcal meningitis in an immunocompetent adult. Cureus 2021; 13(10): e18975. https://doi.org/10.7759/cureus.18975
HAMDAN N, BILLON GRAND R, MOREAU J, THINES L. Cryptococcal meningitis in an immunocompetent patient with obstructive hydrocephalus: a case report. Neurochirurgie 2018; 64: 324-326. https://doi.org/10.1016/j.neuchi.2018.05.178
GARBER ST, PENAR PL. Treatment of indolent, nonencapsulated cryptococcal meningitis associated with hydrocephalus Clin Pract 2012; 2(1): e22. https://doi.org/10.4081/cp.2012.e22
MAHAJAN KR, ROBERTS AL, CURTIS MT, FORTUNA D, DHARIA R, SHEEHAN L. Diagnostic challenges of Cryptococcus neoformans in an immunocompetent individual masquerading as chronic hydrocephalus. Case Rep Neurol Med 2016; 2016: 7381943. https://doi.org/10.1155/2016/7381943
WILLIAMSON PR, JARVIS JN, PANACKAL AA, FISHER MC, MOLLOY SF, LOYSE A, HARRISON TS. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol 2017; 13(1): 13-24. https://doi.org/10.1038/nrneurol.2016.167
TUGUME L, SSEBAMBULIDDE K, KASIBANTE J, ELLIS J, WAKE RM, GAKURU J et al. Cryptococcal meningitis. Nat Rev Dis Primers 2023; 9(1): 62. https://doi.org/10.1038/s41572-023-00472-z
PARK MK., HOSPENTHAL DR., BENNETT JE. Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin Infect Dis 1999; 28(3): 629-633. https://doi.org/10.1086/515161
DEOPUJARI CE, PADAYACHY L, AZMI A, FIGAJI A, SAMANTRAY SK. Neuroendoscopy for post-infective hydrocephalus in children. Childs Nerv Syst 2018; 34(10): 1905-1914. https://doi.org/10.1007/s00381-018-3901-z
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