Chronic meningitis: a diagnostic challenge highlighted in a case of cryptococcal meningoencephalitis in an apparently immunocompetent older woman

Abstract

Chronic meningitis can be difficult to diagnose. The authors report the case of an older Caucasian lady, with no underlying immunocompromising factors, who presented with a 2 month history of confusion. Due to the non-specific symptoms on presentation, a diagnosis was only obtained after a repeat CT scan of the brain, which showed hydrocephalus. Subsequent cerebrospinal fluid analysis showed biochemical abnormalities and Cryptococcus neoformans on staining.

Fungal encephalitis in human autopsy cases is associated with extensive neuronal damage but only minimal repair

“…Unlike bacterial meningitis, which often affects previously healthy neonates, children and adults, fungal infections of the CNS with a few exceptions (e.g. C. neoformans meningitis in heavily exposed persons, victims of Cryptococcus gattii meningoencephalitis and Scedosporium brain abscesses in persons after near‐drowning ) occur in the immunocompromised host. In the present study, all cases included had a history of spontaneous or drug‐induced immunosuppression (transplant recipients, underlying malignant disease, severe septic infections with a prolonged course including multi‐organ failure, alcoholism).…”

Central Nervous System Vasculitis for Cryptococcosis in an Immunocompetent Patient

“…Cryptococcosis affecting immunocompetent patients represents a diagnostic challenge, mainly because it is extremely rare, but also because of it nonspecific clinical manifestations. Consequently, delay in the diagnosis and in the onset of specific treatment is frequently observed [ 10 , 11 ].…”