Young Woman, 27, Diagnosed with Cryptococcal Meningitis After Persistent Fever and Headache – Recovery Achieved Through Timely Antifungal Therapy

Disclaimer: This article is intended solely for educational and informational purposes. Patient confidentiality has been strictly maintained through anonymization and data modification.

Understanding Cryptococcal Meningitis: A Case Study of Early Diagnosis and Successful Treatment

Cryptococcal meningitis, a serious fungal infection of the central nervous system, can present with non-specific symptoms that often delay diagnosis. This case highlights the journey of a 27-year-old woman who experienced prolonged fever, severe headaches, and neurological decline before receiving an accurate diagnosis at Guangzhou Medical University Second Affiliated Hospital in October 2020. Initially misdiagnosed elsewhere, her condition progressively worsened with vision disturbances and hearing loss—classic signs pointing toward central nervous system involvement.

After comprehensive evaluation including lumbar puncture and metagenomic next-generation sequencing (mNGS), she was confirmed to have cryptococcal meningitis. Prompt initiation of intravenous antifungal therapy led to significant clinical improvement. Her treatment spanned 10 weeks of hospitalization followed by ongoing outpatient monitoring, ultimately resulting in full recovery.

Patient Profile & Clinical Presentation

Age: 27 | Gender: Female | Hospital: Guangzhou Medical University Second Affiliated Hospital | Treatment Duration: 10 weeks inpatient care with follow-up as needed

The patient, referred to as Ms. Zhang for privacy, presented with a one-month history of unexplained high-grade fever and progressive headache originating in the right temporal region before spreading bilaterally and becoming generalized. The pain was described as throbbing and pressure-like, accompanied by nausea, vomiting, tinnitus, dizziness, blurred vision, hearing impairment, gait instability, and limb weakness.

Notably absent were symptoms such as slurred speech, dysphagia, seizures, or altered consciousness, which helped narrow the differential diagnosis. Despite multiple visits to other medical facilities, her symptoms failed to improve—and in fact continued to deteriorate, particularly her sensory functions. Upon referral to our center, we immediately suspected central nervous system infection due to the combination of systemic illness and neurological deficits.

Diagnostic Process: Identifying the Fungal Culprit

Physical examination revealed key neurological signs: neck stiffness with a chin-to-chest distance of four fingerbreadths and a positive Kernig's sign—both indicative of meningeal irritation. Initial imaging showed no structural brain abnormalities or venous sinus issues; however, contrast-enhanced MRI demonstrated leptomeningeal enhancement, suggesting inflammation of the brain's protective membranes.

Paranasal sinus imaging revealed bilateral inflammation in the ethmoid and maxillary sinuses, potentially serving as entry points for pathogens. The definitive diagnosis came from cerebrospinal fluid (CSF) analysis after lumbar puncture: elevated white blood cell count (330 × 10⁶/L), increased protein levels, and crucially, identification of Cryptococcus species via mNGS testing.

A critical clue emerged during patient history collection—her neighbor raised poultry on a rooftop accessible near her living space. Exposure to bird droppings, especially from pigeons or chickens, is a well-documented risk factor for cryptococcal infection, as the fungus thrives in nitrogen-rich environments like avian excrement.

Treatment Strategy: Aggressive Antifungal Intervention

Once diagnosed, a targeted treatment plan was initiated immediately to reduce intracranial pressure and eradicate the fungal pathogen. The therapeutic regimen included:

Intravenous mannitol: To decrease cerebral edema and lower intracranial pressure
Amphotericin B: A potent broad-spectrum antifungal agent effective against Cryptococcus
Fluconazole in saline solution: For sustained antifungal coverage and CNS penetration
Glucose-saline electrolyte infusion: To maintain hydration and prevent imbalances caused by prolonged illness and treatment side effects

This multidrug approach follows international guidelines for managing cryptococcal meningitis, especially in immunocompetent individuals where early aggressive therapy improves outcomes significantly.

Progress and Recovery Timeline

Symptomatic relief began within just 72 hours of starting treatment. The patient's temperature stabilized between 38.2°C and 38.8°C, down from higher spikes previously recorded. Her headache intensity diminished markedly, and physical signs of meningeal irritation, including neck rigidity, gradually improved.

Follow-up lumbar punctures conducted weekly showed consistent progress: CSF white cell counts dropped sharply, and protein levels normalized over time. By the one-month mark, the patient reported minimal residual symptoms and resumed light daily activities under supervision.

After 10 weeks of continuous inpatient management, repeat CSF testing revealed complete normalization of all parameters. With no neurological deficits remaining and stable vital signs, she was discharged with instructions for home-based recovery and regular check-ups.

Post-Discharge Guidance: Preventing Recurrence and Supporting Immunity

Recovery from cryptococcal meningitis requires more than medical treatment—it demands lifestyle adjustments to support long-term health and prevent reinfection. We advised the patient to:

Maintain a balanced routine with adequate sleep and stress reduction
Consume a nutrient-rich diet to strengthen immune function
Engage in moderate physical activity appropriate to her recovery stage
Avoid exposure to potential sources of fungal spores, especially bird habitats and contaminated soil
Monitor closely for any recurrence of symptoms such as headache, dizziness, or visual changes

Family members were educated on warning signs requiring urgent medical attention, ensuring rapid response if complications arise.

Clinical Insights: Why Early Detection Matters

Cryptococcal meningitis remains a life-threatening condition, even in otherwise healthy individuals. While it disproportionately affects those with compromised immunity (such as HIV patients), this case underscores that immunocompetent people are not exempt.

Common manifestations include persistent headache, fever, photophobia, nausea, and cranial nerve dysfunction leading to hearing loss and vision problems. Without timely intervention, increased intracranial pressure can lead to herniation, coma, respiratory failure, and death.

Key takeaways for clinicians and patients alike:

Be vigilant about prolonged neurological symptoms, even without known immune deficiency
Consider fungal etiologies in cases of treatment-resistant meningitis
Leverage advanced diagnostics like mNGS when standard tests are inconclusive
Initiate antifungal therapy promptly while awaiting confirmatory results

Early diagnosis, combined with evidence-based antifungal protocols, dramatically increases survival rates and reduces long-term disability. Public awareness about environmental risk factors—especially contact with birds or decaying organic matter—is essential for prevention.