Persistent meningeal signs despite previous treatment for cryptococcal meningitis -- a case report

Abstract

Cryptococcal meningitis continues to be a life-threatening fungal infection in patients with HIV. Treatment involves a year of antifungal therapy, and persistent meningeal signs months after treatment initiation are uncommon. We report a case of a 29-year-old male with HIV who was diagnosed with cryptococcal meningitis ten months earlier and underwent induction, maintenance and consolidation therapy and ART. Subsequently, he continued to have persistent headaches and developed severe meningeal signs with leptomeningeal enhancement on imaging. This case discusses the importance of keeping both immune reconstitution inflammatory syndrome and a cryptococcal meningitis relapse in the differential diagnosis for patients with persistent meningeal signs.