An unusual clinical presentation of Cryptococcal meningitis: The importance of a detailed history and physical.

PURPOSE

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.

OBSERVATIONS

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.

DISCUSSION AND IMPORTANCE

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.