Cryptococcal meningitis and anti NMDA antibodies in an immunocompetent patient

Abstract

BackgroundCryptococcal meningitis is the most common cause of fungal meningitis, frequently seen in an immunocompromised state. The concomitant presence of cryptococcal meningitis and anti-NMDA receptor antibodies is a new and rare occurrence and the pathophysiology behind the co-occurrence of two has not yet been fully elucidated. To the best of our knowledge, four cases have been reported in the literature so far. Case presentationWe herein report another case of a 56-year-old lady who presented to the emergency with dysarthria, left-sided weakness, and altered sensorium. Case reportMR imaging of the brain revealed hyperintense signals in the cortical and subcortical areas. CSF showed lymphocytic predominance. Cryptococcal antigen and anti-NMDA receptor antibody came out to be positive. Our patient gradually improved on steroids and Fluconazole therapy. ConclusionWhether the cryptococcal infection is related to brain autoimmunity or is a trigger to the development of anti-NMDA receptor antibodies is still ambiguous and is yet to be uncovered. Nevertheless, all immunocompetent patients with cryptococcal meningitis should be tested for anti-NMDA receptor antibodies and further studies are required to attain a better understanding and to explore treatment options.