Abstract text (incl. figure legends and references)

Cryptococcusis is an infection caused by the fungi Cryptococcus neoformans and gatii.¹ Cryptococcal meningitis is generally occurred in immunocompromised patients. It may be seen rarely in immunocompetent individuals with nonspecific and more subtle symptoms.²

case: A 47 Years old man with history of 6 months headache, diplopia and blurred vision Presented to emergency department because of the worsening of his symptoms. The Headache was severe, generalized with nausea, the characteristics were dullness and postural that the patient could not lay down. Examination was revealed a papillary edema, and decreased visual acuity.

Magnetic resonance imaging of brain showed bilateral basal ganglia signal change. Lumbar puncture was done, and the opening pressure was 120 cmH2O. The analysis results were as follow: Appearance semi-clear, white blood cell: 130 (80% lymphocyte), red blood cell: 580, and the CSF biochemistry results were: Glucose: 28 mg/dl and total protein: 59 mg/dl. The study of CSF showed a positive Cryptococcus neoformans PCR. The patient admitted and treatment with Amphotericin B was started. HIV Ab was negative and patient"s immune system was intact. He just had close-contact with pigeon. After 30 days of treatment, Cryptococcus neoformans PCR was negative in secound SCF study. Patient discharged with oral Fluconazole and the headache was completely resolved but the ophtalmic symptoms had partially improved.

Cryptococcusis Should be considered in the differential diagnosis of immunocompetent patients, presenting with prolonged headache.²
Early diagnosis is important, because late treatment may lead to some residual symptoms and sometimes death of patients.

1. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. P.R. Williamson, et al. Nat Rev Neural, 13(2017)

2. Cryptococcus meningitis presented with multiple cerebral infarcts in an immunocompetent patient. Buket Erturk Sengel, et al. IDCases,vol.24(2021)