Background
Cryptococcal meningitis (CM) is a potentially fatal infection caused by the fungus Cryptococcus neoformans invading the central nervous system (CNS). People with HIV/AIDS are more likely to develop CM, although it can also occur in people with other types of immunosuppression, such as idiopathic CD4 lymphocytopenia (ICL).
In the absence of HIV infection, ICL is characterised by a low CD4 T cell level. People with ICL are more likely to get opportunistic infections such as CM.
Case Report
We describe the case of a 45-year-old ICL patient who had acute CM at presentation. The patient had a 10-year history of ICL and had received treatment with a number of drugs, including tacrolimus, cyclophosphamide, and rituximab. He had no other noteworthy medical background.
The patient arrived to the hospital after experiencing headache, fever, nausea, and vomiting for a week. He also suffered from photophobia and a stiff neck. The patient had a non-focal neurological examination and was found to be febrile (39.4°C) during the physical examination.
A white blood cell count of 8,000/L with 70% neutrophils was found by laboratory tests. 100 cells/L represented the patient’s CD4 T cell count. White blood cell examination of the cerebral spinal fluid (CSF) revealed 900 cells/L, with 90% lymphocytes. 100 mg/dL of protein and 30 mg/dL of glucose were found in the CSF. CSF tests for cryptococcal antigen were positive.
After being given an acute CM diagnosis, the patient began therapy with fluconazole and amphotericin B. After receiving therapy, he made a good recovery, and two weeks later, the hospital let him go.
Discussion
Even in the absence of additional risk factors for HIV infection, this case report emphasises the significance of taking CM into account in patients with ICL. CM is a severe infection that, if left untreated, can be fatal. The prognosis of people with CM might be improved with early identification and therapy.
The difficulties in treating CM in patients with ICL are also highlighted in the case report. In this instance, the patient had a history of ICL and had received treatment with a number of drugs, including tacrolimus, cyclophosphamide, and rituximab. These drugs may make it more likely for you to have CM.
The patient in this case responded well to treatment with fluconazole and amphotericin B. However, he had a prolonged hospital stay and required multiple courses of antifungal therapy. This case highlights the need for careful monitoring and prolonged treatment in patients with CM who have risk factors for treatment failure.
Conclusion
CM is a severe infection that, if left untreated, can be fatal. Patients who have ICL are more likely to get CM. The prognosis of people with CM might be improved with early identification and therapy.
Reference
Acute Cryptococcal Meningitis in a Patient With Idiopathic CD4 Lymphocytopenia: A Rare Clinical Entity: https://www.cureus.com/articles/174049-acute-cryptococcal-meningitis-in-a-patient-with-idiopathic-cd4-lymphocytopenia-a-rare-clinical-entity#!/
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