A Frontal Cryptococcal Abscess in an HIV-Negative Patient: A Case Report and Overview of Literature

Abstract

Background: Cryptococcus has been occurring in an increasing number of immunocompetent individuals, with a worse response rate to available therapies as compared with classical immunosuppressive patients. Case presentation: Herein, we report a rare case of a cryptococcal brain abscess in an immunocompetent patient. This 25-year-old woman presented with a progressively worsening headache, a persistent fever, and a 2.4×2.2×2.0 cm frontal abscess. Cerebrospinal fluid (CSF) and blood cultures confirmed cryptococcal infection. She was administered standard antifungal treatment. The intracranial lesion shrunk and her clinical condition improved. However, medical therapy alone failed due to sustained high intracranial pressure during the consolidation phase and subsequent antibacterial treatment. Surgical excision confirmed a frontal abscess due to Cryptococcus neoformans. She had complete resolution following surgery. Conclusions: Although medical therapy alone may be effective for small abscesses (<2.5 cm), this case highlights that if the patient has persistently high intracranial pressure, a combined medical and surgical approach is optimal for disease management.