VCOM Louisiana Research Day Program Book 2024

Case Studies

Kevin Le, OMS-III 1 ; Erika Lytle, OMS-III 1 ; Hector Brunet, MD 2 1 VCOM-Louisiana; 2 Willis-Knighton Health System 50 IMMUNOCOMPETENT CRYPTOCOCCAL MENINGITIS: A CASE REPORT

Background: While on a selective clinical rotation in infectious disease, we saw a myriad of interesting and unique patient cases. Among the more peculiar cases was that of a 63-year old Caucasian male, an immunocompetent patient who presented to the emergency room with general weakness, abdominal pain, and diplopia. After consults with neurology and infectious disease were acquired, it was determined this patient needed a lumbar puncture to evaluate any infectious processes within his CSF. With these results, it was suspected that the patient was suffering from cryptococcus meningitis, however several abnormal values in the lumbar puncture lead to the need for cultures to diagnose the infection. After we obtained the cerebral spinal fluid cultures, it became apparent that the patient was suffering from a case of immunocompetent cryptococcal meningitis. Objective: This case report exemplifies the importance of hastily recognizing rare infections, specifically among the immunocompetent population, and how to adequately treat patients within a timely manner. Further, patients diagnosed with cryptococcosis are more likely to have underlying undiagnosed immunocompromised conditions, predisposing them to such infections more easily.

However, the patient in this case was notably immunocompetent, meaning he was likely unknowingly pseudo-immunocompromised. In studying this case, healthcare teams can better understand the pathophysiologies of rare diseases afflicting the immunocompromised and come to better understand the intricacy these rare diagnoses may present as. Lastly, when seemingly immunocompetent individuals are suffering with these unordinary diseases, the mortality rate is markedly high at 12%, likely because these patients present much differently than expected. Therefore, this diagnosis must be considered and pursued in any patient with signs and symptoms of meningitis, lymphocytic CSF findings, and elevated opening pressure. Cryptococcal meningitis due to C. neoformans is a relatively rare diagnosis among supposed immunocompetent individuals. As seen with this case, when immunosuppression is not evident, less-considered sources of minor immunosuppression need to be explored. These include but are not limited to, alcoholism, diabetes mellitus, chronic liver disease, and chronic kidney disease. Methods: A 63-year-old Caucasian male presented to the emergency room with complaints of general weakness, headache, diarrhea, abdominal pain, fever, nausea,

vomiting, and diplopia. The patient also reported the headache was present for the past three weeks, while the rest of his symptoms began two days prior to admission, following difficulty with ambulation. The patient was ordered a neurology consultation the next morning, as well as an infectious disease consultation the following day. After obtaining a thorough history and physical exam, paired with an electrocardiogram and urinalysis, the patient’s healthcare team was bewildered. After obtaining cerebrospinal fluid via lumbar puncture, it was still not evident the patient was currently suffering from cryptococcal meningitis due to lower than expected opening pressure of 48 mmH2O. Cryptococcal meningitis in immunocompromised patients can commonly be seen with opening pressures of greater than 200 mmH2O. Cryptococcus neoformans species. Cryptococcus neoformans meningitis is a rare cause of disease seen in immunocompetent individuals. Results: Invasive cryptococcal disease (cryptococcosis) is most commonly caused either by C. neoformans or C. gattii. Epidemiologically, C. neoformans has a worldwide distribution, while C. gattii is more common in tropical, subtropical, and temperate regions. An important distinguishing feature

71 2024 Via Research Recognition Day