Periodicidad semestral: flujo continuo.
ISSN - Electrónico: 2661-6947 / DOI: 10.36015 • LILACS BIREME (19784); LATINDEX (20666)
INTRODUCTION: Cryptococcosis may appear in immunocompetent individuals, with an unusual clinical course that complicates its diagnosis. A severe form of cryptococcosis is observed in the meninges, characterized by intracranial hypertension and high morbidity.
CLINICAL CASE: A 35-year-old immunocompetent male with a history of head trauma and SARS-CoV-2 infection. The patient presented with an acute clinical picture after two days of fever, holocranial headache (VAS 10/10), photophobia, retro-orbital pain, nausea, and vomiting.
Initial laboratory studies showed leukocytosis, elevated C-reactive protein, decreased CD4 and CD8 cell counts, and hydrocephalus on CT scan, with an Evans index of 0.32. CSF analysis revealed hypoglycorrhachia and a positive culture for Cryptococcus neoformans. Induction therapy was initiated with Amphothericin B and Fluconazole, with hypokalemia and elevated blood
urea nitrogen (BUN) levels reported as adverse effects, which resolved. Two weeks later, a follow-up lumbar puncture with CSF culture was negative, with biochemical improvement. Imaging studies revealed non-communicating hydrocephalus, prompting neurosurgical evaluation for ventriculoperitoneal shunt placement.
DISCUSSION:
This was an unusually acute clinical presentation with no apparent immunosuppression, where occupational exposure or subclinical immunological alterations may have played a role in its development. Cryptococcosis should be considered in the differential diagnosis
of meningitis in immunocompetent patients, especially when hydrocephalus is present or when CSF analysis reveals glucose consumption. Early diagnosis, careful monitoring of cerebrospinal fluid, and antifungal treatment have positive patient outcomes.
CONCLUSIONS: Cryptococcal meningitis can occur in immunocompetent patients. Timely diagnosis via lumbar puncture and immediate initiation of antifungal treatment are key to reducing neurological complications and improving prognosis.
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