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Case Reports
. 2023 Aug 13;15(8):e43417.
doi: 10.7759/cureus.43417. eCollection 2023 Aug.

Acute Cryptococcal Meningitis in a Patient With Idiopathic CD4 Lymphocytopenia: A Rare Clinical Entity

Vaishnavi Kavirayani  1 , Arundhati Negi  1 , M Mukhyaprana Prabhu  1
Affiliations
Case Reports

Acute Cryptococcal Meningitis in a Patient With Idiopathic CD4 Lymphocytopenia: A Rare Clinical Entity

Vaishnavi Kavirayani et al. Cureus. .

Abstract

Cryptococcal meningitis is a known cause of opportunistic infection in immunocompromised patients, especially those with AIDS. Very few cases exist in literature where cryptococcal meningitis is seen in patients without evidence of HIV infection. Here, we describe a case of an elderly woman presenting with clinical features of meningitis. Our patient tested positive for cryptococcal antigen (CRAg) in the CSF and growth of Cryptococcus neoformans was obtained in CSF culture. Further laboratory investigations revealed CD4 lymphocytopenia (233 cells/μl) in the absence of HIV infection. When we checked the CD4 count, beyond a period of six weeks, it was reported to be low, which confirmed our diagnosis of idiopathic CD4 lymphocytopenia (ICL). She was successfully treated with amphotericin B along with flucytosine for two weeks and discharged on maintenance antifungal therapy for eight weeks. This case emphasizes the need to maintain a high index of suspicion and consider the possibility of opportunistic infections even in the absence of HIV infection for timely diagnosis and treatment.

Keywords: cryptococcal meningitis; idiopathic cd4 lymphocytopenia; immunocompetent host; lumbar puncture; opportunistic infections.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI brain showing meningeal enhancement
See this image and copyright information in PMC

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