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A difficult case
Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia
  1. Samuel Shribman1,
  2. Alastair Noyce2,
  3. Sharmilee Gnanapavan3,
  4. Jonathan Lambourne4,
  5. Thomas Harrison5,
  6. Frederick Schon6
  1. 1 Department of Neurology, St George’s Hospital, London, UK
  2. 2 Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
  3. 3 Department of Neurology, Royal London Hospital, London, UK
  4. 4 Departments of Infection and Immunology, Royal London Hospital, London, UK
  5. 5 Institute of Infection and Immunity, St George’s University of London, London, UK
  6. 6 Department of Neurology, Croydon University Hospital, Croydon, UK
  1. Correspondence to Dr Samuel Shribman, Department of Neurology, St. George’s Hospital, London SW17 0QT, UK; samshribman{at}gmail.com

Abstract

We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%–27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.

  • infectious diseases
  • meningitis
  • lymphopaenia

https://doi.org/10.1136/practneurol-2017-001800

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    Footnotes

    • Contributors SS and AN drafted the manuscript, designed the figures and table and then revised the manuscript. SG, JL, TH and FS were directly involved in the diagnosis or management of either case and reviewed the manuscript. FS conceived the idea for the case report.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Nicholas Davies, London, UK.

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