Cryptococcal meningoencephalitis in an immunodeficiency virus positive patient coinfected with tuberculosis

Abstract

Background: Cryptococcal meningitis is an inflammation of the meninges due to Cryptococcus fungal infection which commonly invades people living with immunodeficiency virus (PLHIV) with impaired immunity. The disease has a high mortality rate and is frequently misdiagnosed in the early stages due to vague symptoms. This case report aimed to provide information regarding diagnosing and managing cryptococcal meningoencephalitis in patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis. Case presentation: We reported a case of 34-year-old woman that complained of headache and fever from one month ago. There were also oral white patches in the last two weeks. The patient was diagnosed with lung TB and human immunodeficiency virus (HIV) in February 2021, but the TB was just being treated in the past two months and HIV in last two weeks. Head CT-scan with contrast showed meningoencephalitis, brain edema, left frontal, left ethmoidal, left and right maxillary and left sphenoid sinusitis. On the 9th day of hospitalization, the patient had seizures. Analysis of the cerebrospinal fluid culture revealed Cryptococcus neoformans. The patient’s comorbidities were leucopenia, hypoalbuminemia, pneumonia, brain edema which led to poor prognosis. On the 10th day, the seizures relapsed, followed by the drastically reduced SpO2 and death. Septic shock and multiorgan failure were considered the cause of the case's death. Conclusion: This case highlights the importance of early diagnosis and management to avoid unfavorable outcome.