Abstract
BackgroundClinicians may be less inclined to consider a diagnosis of cryptococcal meningitis in people without HIV infection or transplant-related immunosuppression. This may lead to a delay in diagnosis particularly if disseminated cryptococcal disease mimics cerebral septic emboli in injection drug use (IDU) leading to a search for endocarditis or other infectious sources. Though, IDU has been described as a potential risk for disseminated cryptococcal disease.Case presentationsWe present two cases of cryptococcal meningitis in IDU without HIV or other obvious immune deficits. Both patients presented with at least 2 weeks of headache and blurred vision. They developed central nervous system (CNS) vasculitis, one of which mimicked septic cerebral emboli, but both resulted with poor neurologic outcomes.ConclusionsIDU likely induces an underappreciated immune deficit and is a risk factor for developing cryptococcal meningitis. This diagnosis, which can mimic cerebral septic emboli through involvement of a CNS vasculitis, should be considered in the setting of IDU.
Highlights
Clinicians may be less inclined to consider a diagnosis of cryptococcal meningitis in people without Human immunodeficiency virus (HIV) infection or transplant-related immunosuppression
While physicians may be familiar with the presentation of cryptococcal meningitis in people living with HIV, clinicians may be less inclined to consider the diagnosis in other patient populations leading to a delay in diagnosis
Appreciation of non-HIV risk factors for cryptococcal disease may be helpful for physicians, with risk for cryptococcal disease described in organ transplant recipients
Summary
IDU likely induces an underappreciated immune deficit and is a risk factor for developing cryptococcal meningitis.
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