A Rare Case of Asymptomatic Cryptococcal Meningitis with Cryptococcal Pneumonia Case Report

Abstract

lobes (endobronchial spread of infection in right middle lobe and right lower lobe). She was admitted to our hospital for further evaluation.Infectious diseases and Pulmonary were involved in the case, she was in airborne isolation and bronchoscopy was performed to rule out pulmonary tuberculosis. The acid-fast bacillus sputum culture (AFB) was negative x3, patient underwent bronchoalveolar lavage (BAL), which was negative for PCP and AFB. Serum Cyptocococcal neoformans capsular polysaccharide antigen was positive CRAg (1:2560), repeated was1:20, Absolute CD4 count was7. Initial CSF opening pressure was 36, WBCs 0, RBCs 2, colorless, protein 18.8, glucose 43, CSF fungal culture showed positive encapsulated yeast, India ink microscopy.Meanwhile, the patient was receiving treatment with Flucytosine, Amphotericin B and Cefepime. She underwent serial therapeutic lumbar puncture for 14 days. Despite the treatment with antifungal and serial LP, the patient had persistently raised CSF pressure. She did not complain of neuropsychiatric symptoms or signs such as neck stiffness, headache, dizziness, photophobia, lethargy, altered mental status, personality changes or memory loss. Brain CT was negative for hydrocephalus. Neurosurgery was involved for placement of lumbar drain or ventricular drain, either directly draining externally or a ventricular-peritoneal shunt. Ophthalmology was consulted to assess for papilledema, which was negative. As the patient was asymptomatic denied headaches, visual changes, or symptoms associated with elevated intracranial pressure (ICP) V-P shunt was not performed. The WBCs was serially followed, which showed a drop of all cell line after induction treatment with Flucytosine, Amphotericin B and Cefepime. The patient remained asymptomatic during the entire clinical course. The final report of BAL analysis: Grocott stain positive for yeast form fungal microorganisms, Cryptococcus. The mucicarmine stain showed highlights organism with positive capsular staining supporting the possibility of Cryptococcus infection. The patient didn't complete the treatment, she left the facility against medical advised (AMA) and was lost follow-up.