Cryptococcal Central Nervous System Infection in an Immunocompetent Older Adult Associated with an Accessory Spleen: A Case Report
Cryptococcal Central Nervous System Infection in an Immunocompetent Older Adult Associated with an Accessory Spleen: A Case Report
DOI:
https://doi.org/10.47187/cssn.Vol17.Iss1.497Keywords:
Cryptococcosis, Cryptococcal meningitis, Immunocompetent host, Central nervous system infection, Case reportAbstract
Introduction: WCryptococcosis is a systemic fungal infection commonly associated with immunosuppression, particularly in individuals living with human immunodeficiency virus (HIV). It is estimated to cause approximately 223,000 cases of cryptococcal meningitis and 180,000 deaths annually worldwide, representing a significant cause of morbidity and mortality. Early diagnosis and prompt treatment are essential to reduce severe complications and improve clinical outcomes. The disease is caused by encapsulated yeasts of the genus Cryptococcus, and diagnosis is based on direct microscopy, cryptococcal antigen detection, culture, and molecular methods. Case Presentation: We describe the case of a 65-year-old immunocompetent man who initially presented with respiratory symptoms followed by progressive neurological manifestations. Laboratory evaluation revealed negative HIV serology. Cerebrospinal fluid (CSF) examination demonstrated encapsulated yeasts on India ink staining, confirming cryptococcal central nervous system infection. Notably, cryptococcal antigen testing in both serum and CSF was negative despite positive direct microscopy, a finding suggestive of diagnostic interference such as the prozone phenomenon. Brain neuroimaging showed no significant abnormalities. The patient received antifungal therapy with favorable clinical response and complete resolution of neurological symptoms. An accessory spleen was identified as an incidental finding during the diagnostic workup. After 19 days of hospitalization, the patient was discharged without neurological sequelae. Conclusions: Central nervous system cryptococcosis in immunocompetent individuals is uncommon and may pose a diagnostic challenge because of its low prevalence and nonspecific clinical presentation. This case highlights the importance of maintaining a high index of suspicion, recognizing
potential limitations of cryptococcal antigen testing, and initiating timely antifungal therapy to improve outcomes and prevent complications.
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