Fulminant cryptococcal meningoencephalitis with adrenal involvement in an immunocompetent patient: a clinicopathologic correlation.
Luiza Barbosa de Oliveira, Thrícia Christina Garcia Diniz Rezende, Isadora Lyrio Stábille et al.
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Case in brief
A 65-year-old immunocompetent man presented with severe headache, psychomotor agitation, confusion, and disorganized speech. Initial imaging suggested inactive neurocysticercosis, but cerebrospinal fluid analysis revealed Cryptococcus neoformans. Despite treatment with fluconazole and amphotericin B, and therapeutic lumbar punctures to manage intracranial pressure, the patient deteriorated and died. Autopsy showed cerebral edema and adrenal involvement.
What made this case unusual
The case highlights the rapid progression of cryptococcal meningoencephalitis in an immunocompetent patient, which is atypical for this condition.
Diagnostic / clinical pearl
Clinicians should consider cryptococcal meningoencephalitis in patients with acute neurological symptoms, even in immunocompetent individuals, and prioritize early diagnosis and management.
Why it matters
This case underscores the need for heightened awareness of cryptococcal infections in atypical presentations, emphasizing the importance of prompt intervention to prevent severe outcomes.