Open AccessCryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult
Author(s) -
Hitesh Raheja,
Ankur Sinha,
Pavan Irukulla,
Yizhak Kupfer
Publication year - 2017
Publication title -
journal of global infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.437
H-Index - 25
eISSN - 0974-8245
pISSN - 0974-777X
DOI - 10.4103/jgid.jgid_2_17
Subject(s) - cryptococcus neoformans , medicine , cryptococcus , lumbar puncture , hydrocephalus , meningitis , cryptococcosis , cerebrospinal fluid , lumbar , pleocytosis , pathology , surgery , biology , genetics , microbiology and biotechnology
We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles. A working diagnosis of NPH had been made considering the clinical symptoms and imaging. She became febrile to 103°F. Lumbar puncture was then performed which showed increased protein, decreased glucose, and mononuclear pleocytosis. India ink preparation of the cerebrospinal fluid was positive for Cryptococcus along with a positive cryptococcal antigen test. The patient was started on treatment for CM, but the patient continued to deteriorate further and died on the same day. Blood cultures subsequently grew Cryptococcus neoformans as well.