Cryptococcal meningitis with cerebrospinal fluid human immunodeficiency virus escape presenting as transient diplopia and areflexia.
Jacob August Bell, Jordan Langford, Jakrapun Pupaibool et al.
✦ AI-curated · Sources linked
Case in brief
A man in his early 40s with stable HIV on antiretroviral therapy presented with transient binocular diplopia and areflexia. Neuroimaging was normal, but lumbar puncture revealed elevated opening pressure, lymphocytic pleocytosis, cryptococcal antigen, and growth of Cryptococcus neoformans. He was diagnosed with cryptococcal meningitis and treated with amphotericin B, flucytosine, and fluconazole, leading to resolution of neurological symptoms.
What made this case unusual
The case demonstrated detectable cerebrospinal fluid HIV RNA despite serum viral suppression, indicating HIV escape in the central nervous system.
Diagnostic / clinical pearl
Transient visual symptoms may indicate cryptococcal meningitis, potentially due to elevated intracranial pressure.
Why it matters
CSF HIV escape should be considered in patients with CNS disease progression despite controlled HIV viral load and adequate CD4 counts.