Molina Guarina, Perozo Maria A, Mora Ruben, Stratidis John, Freites Nathalie
Internal Medicine, Danbury Hospital, Danbury, USA.
Infectious Diseases, Danbury Hospital, Danbury, USA.
Cureus. 2023 Aug 8;15(8):e43121. doi: 10.7759/cureus.43121. eCollection 2023 Aug.
Cryptococcal meningitis is a severe fungal infection that primarily affects individuals with compromised immune systems, such as those with the human immunodeficiency virus (HIV) or those undergoing immunosuppressive therapies after organ transplantation. In rare cases, immunocompetent individuals may also be affected by this life-threatening condition. We present the case of a 64-year-old male patient with no known underlying immune deficiency diagnosed with cryptococcal meningitis, who presented with persistent headaches and subjective fevers. Due to the absence of apparent immunosuppressive conditions or identifiable risk factors during evaluation, our suspicion for fungal meningitis was low. However, the diagnosis was confirmed through CSF fluid analysis, leading to the immediate initiation of guideline-directed treatment with amphotericin and fluconazole. This case highlights the importance of considering cryptococcal meningitis in the differential diagnosis of persistent headaches, even in patients without known immune compromise. Early recognition and appropriate management are essential to preventing complications and delays in management and guaranteeing optimal outcomes for all our patients.
隐球菌性脑膜炎是一种严重的真菌感染，主要影响免疫系统受损的个体，如感染人类免疫缺陷病毒（HIV）的人或器官移植后接受免疫抑制治疗的人。在罕见情况下，免疫功能正常的个体也可能受到这种危及生命的疾病的影响。我们报告一例64岁男性患者，无已知潜在免疫缺陷，被诊断为隐球菌性脑膜炎，该患者表现为持续性头痛和主观发热。由于在评估过程中没有明显的免疫抑制状况或可识别的危险因素，我们对真菌性脑膜炎的怀疑度较低。然而，通过脑脊液分析确诊了该诊断，从而立即开始使用两性霉素和氟康唑进行指南指导的治疗。该病例强调了在持续性头痛的鉴别诊断中考虑隐球菌性脑膜炎的重要性，即使是在没有已知免疫功能受损的患者中。早期识别和适当管理对于预防并发症、避免管理延误以及确保所有患者获得最佳治疗效果至关重要。
