{"pk":1093,"title":"An Uncommon Presentation of Cryptococcal Meningitis in an Immunocompetent Patient: A Case Report","subtitle":null,"abstract":"Introduction:\n Meningitis is a serious and potentially life-threatening infection of the central nervous system. Cryptococcus neoformans is a rare fungal cause of meningitis that commonly presents with atypical symptoms. Although this infection is most common in immunocompromised patients, it also occurs in immunocompetent patients. This case report describes an atypical presentation of cryptococcal meningitis in a seemingly immunocompetent patient.\nCase Report:\n A 40-year-old immunocompetent patient with no significant past medical history had visited the emergency department (ED) five times within a span of 30 days reporting dental pain and headache. Throughout each of the visits, no clear symptoms signaling the need for a meningitis workup were observed, as the patient had been afebrile, displayed no nuchal rigidity, and his presenting symptoms subsided within the ED after treatment. A lumbar puncture was performed after emergency medical services brought the patient in for his sixth ED visit, initially for stroke-like symptoms and altered mental status. Spinal fluid was indicative of cryptococcal meningitis.\nConclusion:\n This case highlights the challenge of identifying cryptococcal meningitis in the ED, particularly in immunocompetent patients who do not display classic meningitis symptoms. It also highlights the importance of keeping a broad differential and carefully ruling out diagnoses when patients return to the ED multiple times for the same complaint.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"case report"},{"word":"immunocompetent"},{"word":"cryptococcal meningitis"},{"word":"altered mental status"},{"word":"headache"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8xb9v5d5","frozenauthors":[{"first_name":"Kelly","middle_name":"","last_name":"Correa","name_suffix":"","institution":"Henry Ford Wyandotte Hospital, Department of Emergency Medicine and Graduate Medical Education, Wyandotte, Michigan","department":"None"},{"first_name":"Scott","middle_name":"","last_name":"Craver","name_suffix":"","institution":"Ascension St. Vincent Indianapolis Hospital, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Amar","middle_name":"","last_name":"Sandhu","name_suffix":"","institution":"Henry Ford Wyandotte Hospital, Department of Emergency Medicine, Wyandotte, Michigan","department":"None"}],"date_submitted":"2021-10-12T23:09:48Z","date_accepted":"2021-10-12T23:09:48Z","date_published":"2021-10-12T23:11:34Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1093/galley/834/download/"}]}