Saeed Arif, Khushbakht Ghazanfar, Waseem Wali Muhammad, Hamza Malik


Cryptococcal meningitis (CM) is life threatening fungal infection of central nervous system (CNS). Although it is commonly associated with immunosuppression but rarely it can occur in immune competent patient. We report a case of 21 year old non HIV infected girl. Based on initial diagnoses of tuberculosis Bacillus meningitis (TBM), she was started on anti-tuberculosis treatment (ATT). However failure to respond to treatment prompted a quest for alternative diagnosis. A final Diagnosis of CM was confirmed on latex agglutination antigen detection on cerebrospinal fluid (CSF) analysis. The patient responded well to antifungal treatment. Initially diagnosis was missed due to common occurrence of tuberculosis infection in Pakistan and resemblance of its symptomatology and magnetic resonance imaging (MRI) findings with CNS cryptoccocal infection.

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Chowdhary A, Rhandhawa HS, Prakash A, Meis JF. Environmental prevalence of Cryptococcus neoformans and Cryptococcus gattii in India: An update. Crit Rev Microbiol 2012;38(1):1–16.

Baddley JW, Perfect JR, Oster RA, Larsen RA, Pankey GA, Henderson H, et al. Pulmonary cryptococcosis in patients without HIV infection: Factors associated with disseminated disease. Eur J Clin Microbiol Infect Dis 2008;27(10):937–43.

Goldman JD, Vollmer EM, Luks AM. Cryptococcosis in the immunocompetent patient. Respir Care 2010;55(11):1499–503.

Fica A, Soto A, Dabanch P J, Pinilla J, Porte L. [Cryptococcal infections in non-HIV infected patients: a new clinical problem in Chile]. Rev Chilena Infectol 2015;32(1):99–105.

Sittambalam CD, Hanna H, Martello J, Mitsani D. Cryptococcus infection in a non-HIV patient: a case report. J Community Hosp Intern Med Perspect 2012;2(3).

Zhu LP, Wu JQ, Xu B, Ou XT, Zhang QQ, Weng XH. Cryptococcal meningitis in non-HIV-infected patients in a Chinese tertiary care hospital, 1997–2007. Med Mycol 2010;48(4):570–9.

Shih CC, Chen YC, Chang SC, Luh KT, Hsieh WC. Cryptococcal meningitis in non-HIV-infected patients. QJM. 2000;93(4):245–51.

Revest M, Decaux O, Frouget T, Cazalets C, Albert JD, Chevrier S, et al. [Cryptococcal infections in non-HIV infected patients. Study of four cases and review of literature]. Rev Med Interne 2006;27(3):203–8.

Dismukes WE. Cryptococcal meningitis in patients with AIDS. J Infect Dis 1988;157(4):624–8.

Sarkis RA, Mays M, Isada C, Ahmed M. MRI findings in cryptococcal meningitis of the non-HIV population. Neurologist 2015;19(2):40–5.

Donnet A, Graziani N, Harlé JR, Durand JM, Touta A, Grisoli F. [Neurological form of cryptococcosis. Apropos of 2 atypical cases in non HIV-infected patients]. Rev Neurol (Paris) 1993;149(5):326–30.

Tripathi S, Patro I, Mahadevan A, Patro N, Phillip M, Shankar SK. Glial alterations in tuberculous and cryptococcal meningitis and their relation to HIV co-infection--a study on human brains. J Infect Dev Ctries 2014;8(11):1421–43.

Canteros CE, Brudny M, Rodero L, Perrotta D, Davel G. [Distribution of Cryptococcus neoformans serotypes associated with human infections in Argentina]. Rev Argent Microbiol 2002;34(4):213–8.


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