Cryptococcal meningitis caused by Cryptococcus neoformans in an immunocompetent soldier

BACKGROUND: Cryptococcus neoformans is an encapsulated yeast that commonly causes disease in individuals in the setting of immunocompromised states. It is rarely reported in immunocompetent patients in the literature.

HIGHLIGHT OF A REPORT: An active duty service member with no significant medical history presented with persistent headache, nausea, vomiting, weight loss, and nocturnal fevers for 2 months. The patient was admitted to the hospital where a lumbar puncture was performed showing an elevated white blood cell count, low glucose, and elevated protein. Subsequent cerebral spinal fluid analysis yielded cryptococcal antigen latex screen and culture which speciated C. neoformans. The patient received fluconazole and flucytosine, and completed a 10-week course to result in a full recovery.

CONCLUSION: C. neoformans is found throughout the world in soil contaminated with bird droppings and usually causes infection and disease in individuals who are immunosuppressed. Rare case reports exist where C. neoformans causes central nervous infection in immunocompetent hosts. This fungal etiology should be considered in all patients presenting with meningitis symptoms and a cerebral spinal fluid panel with low glucose and high protein, or without a clear bacterial etiology. This case illustrates the importance of broadening the differential when previously healthy service members present with common or nonspecific symptoms.