Fungal meningitis in an immunocompetent patient.

Cryptococcal meningitis is a rare entity among immunocompetent hosts but, when it occurs, it is associated with significant morbidity and mortality. Clinical presentation as well as the course of the disease is usually subtle and indolent with headache and altered mental status. The authors present the case of a 59-year-old man, who sought medical help with a 2-week history of headaches accompanied by nausea and visual and hearing disturbances. On admission the patient was afebrile, presented visual and hearing deficits and had a normal magnetic resonance image of the brain. A lumbar puncture was performed and microscopic examination of the cerebrospinal fluid revealed yeasts that were identified as Cryptococcus spp. and later, by means of molecular biology techniques, as Cryptococcus neoformans, var. grubii. The patient was treated with liposomal amphotericin B plus fluconazole for 28 weeks. At follow-up after 1 year the patient was asymptomatic and received fluconazole 400 mg/day as prophylactic therapy. The outcome of Cryptococcus infections in immunocompetent hosts is reported to be poor as a result of a delayed diagnosis and suboptimal initial antifungal therapy. The influence of the normal immune response is unclear.