Title : Unmasking disseminated cryptococcosis in an immunocompetent host: A diagnostic challenge with life-threatening implications
Abstract:
Background:
Disseminated cryptococcosis is typically associated with immunocompromised states but can rarely affect immunocompetent individuals, leading to diagnostic delays and increased morbidity. Prompt recognition and treatment are essential for survival.
Case Presentation:
A 34-year-old previously healthy female presented with a 3-week history of progressive headache, nausea, and intermittent low-grade fever. Initial neurological examination was non-focal. Brain CT was unremarkable. Lumbar puncture revealed elevated opening pressure (35 cm H?O), lymphocytic pleocytosis, low glucose, and elevated protein. Cryptococcal antigen and India ink stain confirmed cryptococcal meningitis. HIV and other immunosuppression screens were negative. Despite initiation of antifungal induction therapy with liposomal amphotericin B and flucytosine, the patient developed new respiratory symptoms. Chest CT showed diffuse bilateral pulmonary nodules; bronchoalveolar lavage confirmed pulmonary cryptococcosis, confirming dissemination.
Management and Outcome:
The patient continued antifungal therapy with close monitoring of intracranial pressure and respiratory status. Over six months, clinical and radiological improvements were noted, with resolution of neurological symptoms and pulmonary infiltrates. Maintenance therapy with oral fluconazole was continued with no relapse at one-year follow-up.
Conclusion:
This case highlights the critical need to consider disseminated cryptococcosis even in immunocompetent hosts presenting with meningitis and systemic symptoms. Multimodal diagnostic testing, including CSF studies and pulmonary imaging, is crucial for early detection. Early aggressive antifungal treatment and supportive care significantly improve outcomes. Clinicians must maintain vigilance for atypical infectious presentations to reduce diagnostic delays and associated mortality.
