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- Cryptococcal meningitis is the most common fungal CNS infection that predominantly affects immunocompromised patients.
- However, cases have been described in immunocompetent patients.
- Clinical presentation may include headache, fever, neck pain, nausea, vomiting, light sensitivity, seizure, or altered mental status.
- Neuroimaging is usually normal, though cryptococcomas, pseudocysts, and obstructing hydrocephalus can be seen.
- Diagnosis with LP include elevated opening pressure, mononuclear predominance of cell count, low glucose, high protein, India ink microscopy, Cryptococcal antigen testing, and CSF culture.
- Subacute symptoms contribute to delay in diagnosis which increases overall morbidity and mortality.
Bottom Line: Consider cryptococcal meningitis even in immunocompetent patients.