Cryptococcal meningitis is the most common fungal CNS infection that predominantly affects immunocompromised patients.
However, cases have been described in immunocompetent patients.
Clinical presentation may include headache, fever, neck pain, nausea, vomiting, light sensitivity, seizure, or altered mental status.
Neuroimaging is usually normal, though cryptococcomas, pseudocysts, and obstructing hydrocephalus can be seen.
Diagnosis with LP include elevated opening pressure, mononuclear predominance of cell count, low glucose, high protein, India ink microscopy, Cryptococcal antigen testing, and CSF culture.
Subacute symptoms contribute to delay in diagnosis which increases overall morbidity and mortality.
Bottom Line: Consider cryptococcal meningitis even in immunocompetent patients.
