[Neuromeningeal cryptoccosis in an HIV-negative patient in Bamako, Mali].

Abstract

Introduction/rationale: Neuromeningeal cryptococcosis (NMC) is a common fungal infection in immunocompromised patients with HIV infection. Its rarity outside HIV/AIDS requires a systematic search for other immunosuppressive factors and a differential diagnosis. We report a case of NMC in an immunocompetent patient admitted to the Point G University Hospital Center in Bamako, Mali.

Case description: The patient presented with fever (39.3°C), general deterioration, Glasgow Coma Scale score of 10/15 without motor deficits, neck stiffness, and helmet-like headache unresponsive to analgesics. The patient had a CD4 count of 932 cells/mm³. No other immunosuppressive conditions were noted. The diagnosis of NMC was confirmed based on clinical and microbiologic findings. The patient was successfully treated in Bamako using an alternative protocol with fluconazole, a more accessible, less expensive treatment with fewer side effects compared to amphotericin B.

Discussion/conclusion: The occurrence of cryptococcosis in an immunocompetent host is rare. However, it can occur in the absence of predisposing factors. Fluconazole is an effective alternative therapy.