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CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 4  |  Page : 157-159

Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immune-competent adult


1 Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
2 Division of Pulmonary Medicine and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY, USA

Correspondence Address:
Dr. Hitesh Raheja
Department of Internal Medicine, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgid.jgid_2_17

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We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles. A working diagnosis of NPH had been made considering the clinical symptoms and imaging. She became febrile to 103°F. Lumbar puncture was then performed which showed increased protein, decreased glucose, and mononuclear pleocytosis. India ink preparation of the cerebrospinal fluid was positive for Cryptococcus along with a positive cryptococcal antigen test. The patient was started on treatment for CM, but the patient continued to deteriorate further and died on the same day. Blood cultures subsequently grew Cryptococcus neoformans as well.


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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008