Cryptococcal Meningitis in a Young Immunocompetent Male from Northern India: A Rare Case Report

Background: Cryptococcal meningitis(CM) is a fungal infection of the brain and meninges that can be fatal if untreated, and it is mostly linked to advanced HIV infection or other states of weakened immunity. A growing number of cases are now being described in people with no such risk factors, where the illness can be easy to miss due to mild symptoms and normal CSF(Cerebrospinal fluid) findings.
Case Findings: An 18-year-old man with no prior illness, from northern India, came to hospital after two months of worsening whole-head headache and occasional low-grade fever, confusion and marked drowsiness developing over the final three days. Changes in behaviour and drop in his college performance in the preceding weeks were seen. On neurological assessment, he was disoriented and slow to respond, but there were no focal deficits or signs of meningeal irritation. Routine blood work and biochemistry were unremarkable, and HIV test was negative. MRI showed no abnormality. CSF examination found it clear, with normal opening pressure, near-normal glucose and protein, and only a small number of lymphocytes. Because of long course of illness, fungal causes were investigated next: India ink showed encapsulated, budding yeast cells, cryptococcal antigen test was positive, and fungal culture grew Cryptococcus species. He improved substantially on intravenous amphotericin B followed by oral fluconazole, with full clinical recovery and clearance of the organism on repeat testing.
Conclusion: Even in patients with no immune impairment, CM deserves consideration whenever chronic meningitis is the differential, particularly when CSF abnormalities are only mild.