Cryptococcal Meningitis in an Apparently Immunocompetent Individual: A Case Report

Abstract

Cryptococcus neoformans, a saprophyte, is commonly found in soil contaminated with pigeon droppings but has also been isolated from the wood of several tree species in South America and India, including the flowers and bark of eucalyptus trees. Inhalation of small, encapsulated yeasts may lead to an initial pulmonary infection. However, this is usually short-lived and frequently silent, especially in immunocompetent individuals. Immunocompromised patients are usually tested for Cryptococcus as a causative agent when presenting with features of meningitis, but when dealing with immunocompetent patients, it is seldom considered. This report presented a case of a 39-year-old male who was apparently immunocompetent, yet developed cryptococcal meningitis. He had no prior history of any chronic illness, malignancy, immunosuppressive medication, or steroid use. Routine blood investigations were within normal limits. Autoimmune workup and viral markers were negative. He had raised Intracranial Pressure (ICP), Cerebrospinal Fluid (CSF) leukocytosis, and encapsulated yeast forms consistent with cryptococcal meningitis initially demonstrated by CSF cytology examination with Papanicolaou stain and May-Grunwald-Giemsa, and further confirmed by special stains. This case highlights the role of initial cytological workup in detecting cryptococcal infection through morphological and special stain studies in an immunocompetent host.