Nakahira Shay, Yamamoto Marcus, Wood Terry
John A. Burns School of Medicine, University of Hawai'i at Manoa, USA.
Hawaiian Eye Center, Wahiawa, HI, USA.
IDCases. 2025 Jul 5;41:e02311. doi: 10.1016/j.idcr.2025.e02311. eCollection 2025.
Cryptococcal meningitis is a severe fungal infection that can present with a highly variable range of neuro-ophthalmic and systemic symptoms. Although more classically associated with immunocompromised individuals, it has increasingly been reported in immunocompetent hosts. Cryptococcus neoformans is typically linked to opportunistic infections in immunosuppressed populations, whereas Cryptococcus gattii more commonly affects immunocompetent individuals.
A healthy 40-year-old female presented with new onset recurrent headaches. After a normal MRI, she was re-assured by multiple physicians and given a presumptive diagnosis of stress induced migraine, as she had recently experienced the sudden unexpected death of her husband. Persistent and progressive headaches, focusing difficulties, and extreme photosensitivity prompted her to seek further evaluation by an ophthalmologist, who diagnosed her with Cryptococcal meningitis based on her lumbar puncture results.
Despite the initial clinical impression being suggestive of migraines, the patient was ultimately diagnosed with cryptococcal meningitis one month from the initial onset of her symptoms, with rapid advancement to an emergent situation ultimately resulting in two hospitalizations where she received numerous spinal fluid drainages, anti-fungal medications and a lumbar shunt. This case underscores the importance of comprehensive history-taking, clinical vigilance, and maintaining a broad differential diagnosis in the workup of any patient. Ocular symptoms, in this instance, served as an early manifestation of cryptococcal meningitis in an immunocompetent patient, highlighting the need for heightened awareness in clinical practice to ensure timely diagnosis and appropriate management.
隐球菌性脑膜炎是一种严重的真菌感染，可表现出范围高度可变的神经眼科和全身症状。虽然传统上更多地与免疫功能低下的个体相关，但越来越多的报告显示其在免疫功能正常的宿主中也有出现。新型隐球菌通常与免疫抑制人群的机会性感染有关，而加氏隐球菌更常见于免疫功能正常的个体。
一名40岁健康女性出现新发复发性头痛。在MRI检查正常后，多位医生让她放心，并初步诊断为应激性偏头痛，因为她最近经历了丈夫的突然意外死亡。持续且逐渐加重的头痛、注意力难以集中以及极度的光敏性促使她寻求眼科医生的进一步评估，眼科医生根据她的腰椎穿刺结果诊断她患有隐球菌性脑膜炎。
尽管最初的临床印象提示为偏头痛，但该患者最终在症状初发一个月后被诊断为隐球菌性脑膜炎，并迅速发展为紧急情况，最终住院两次，期间接受了多次脑脊液引流、抗真菌药物治疗以及腰椎分流术。该病例强调了在对任何患者进行检查时全面采集病史、保持临床警惕性以及维持广泛鉴别诊断的重要性。在这种情况下，眼部症状是免疫功能正常患者隐球菌性脑膜炎的早期表现，凸显了临床实践中提高认识以确保及时诊断和适当治疗的必要性。
