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A Rare Case of Cryptococcus Meningoencephalitis Presenting with Acute Brainstem Infarction in an Immunocompetent Host

Author(s): Chun-Hao Lai, Guan-Yu Lin, Jiunn-Tay Lee, Hung-Wen Kao, Tsung-Han Ho, Yu-Kai Lin, Yu-Wei Hsu1, Fu-Chi Yang


Background: Cryptococcal meningitis (CM) occurs most commonly in immunocompromised patients. Here, we report a rare case of CM in an immunocompetent patient who presented with an acute stroke.

Case report: A 60-year-old woman came to our hospital with complaints of dizziness, dysarthria, and a right side-deviated gait. A head computed tomography (CT) showed a low-density lesion in the left caudate, consistent with recent infarction. Within a day of admission, she developed headache, fever, and a mild Brudzinski’s sign. Magnetic resonance imaging showed an acute lacunar infarct in the left midbrain as well as vasogenic edema in the left caudate head and left genu of the corpus callosum. A cerebrospinal fluid (CSF) examination showed elevated opening pressure, a high white blood cell count, a low glucose level, and a high protein level. CSF pathology revealed Cryptococcus neoformans yeast cells and C. neoformans was cultured from a CSF sample. The patient was treated with curative antifungal and prophylactic antiplatelet medications and recovered without long-term sequelae.

Conclusion: CM should be considered as a differential diagnosis in acute stroke patients with fever and potential pathogen-contact history, even if they are non-immunocompromised. Missed CM diagnosis can result in inappropriate management, affecting the patient’s clinical outcome.

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