Abstract
BackgroundManaging HIV-associated cryptococcal meningitis (CM) can become challenging in the presence of concurrent unusual central nervous system infections.Case presentationA 58-year old HIV infected woman new ART starter, who was being treated effectively for cryptococcal meningitis, represented with worsening of neurological symptoms. Brain MRI revealed a multicystic lesion in the left temporal lobe. Anti-fungal treatment was escalated for a suspected cryptococcoma, but post-mortem CSF serological test confirmed racemose neurocysticercosis.ConclusionPatients with HIV-associated CM are highly immunocompromised and may have multiple pathologies simultaneously. In endemic countries, neurocysticercosis should be considered in the differential diagnosis where there is central nervous system deterioration despite effective therapy for CM.
Highlights
Managing Human Immunodeficiency Virus (HIV)-associated cryptococcal meningitis (CM) can become challenging in the presence of concurrent unusual central nervous system infections
We describe a case of coincidental racemose neurocysticercosis in a patient being treated for HIV-associated cryptococcal meningitis, clinically and microbiologically responding to antifungal therapy
Post-mortem, a neurocysticercosis enzyme-linked immunoelectrotransfer blot (EITB) assay was positive for cysticercosis on Cerebrospinal fluid (CSF) but negative on serum. It was performed in the Department of Clinical Parasitology, Hospital for Tropical Diseases London. This case demonstrates the difficulties of managing CM in limited resource settings and the diagnostic challenges encountered when a patient with known CM presents with neurological deterioration late in the course of treatment
Summary
Managing HIV-associated cryptococcal meningitis (CM) can become challenging in the presence of concurrent unusual central nervous system infections. We describe a case of coincidental racemose neurocysticercosis in a patient being treated for HIV-associated cryptococcal meningitis, clinically and microbiologically responding to antifungal therapy. * Correspondence: nkalata@mlw.mw 1Malawi Liverpool Wellcome Trust Clinical Research Programme, Liverpool, UK 2Internal Medicine Department, College of Medicine University of Malawi, Malawi, UK
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