ArticleMedical mycology case reports2025
The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report.
Article in Medical mycology case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Cryptococcal meningitis is one of the major causes of death in sub-Saharan Africa among individuals with advanced HIV, and it is typically diagnosed through lumbar puncture (LP). However, LP may be contraindicated in some cases, causing a clinical dilemma and potential delay in treatment. We present the case of a 60-year-old female, newly diagnosed with HIV, who presented with a reduced level of consciousness and a positive serum cryptococcal antigen (CrAg) test (high titer = 1:320). Computerized tomographic (CT) brain imaging showed multiple nodular lesions, peri-lesional edema and a midline shift. Despite the contraindication for LP, a low volume lumbar puncture (1-2 mL) was performed in view of the elevated serum CrAg titers and patient's clinical symptoms, in order to rule in a definitive diagnosis of cryptococcal meningitis or exclude tuberculous meningitis. The patient was treated for cryptococcal meningitis and responded well. In patients with a positive serum CrAg test and contraindications to LP, an elevated titer (>1:160) and neurological symptoms may guide the initiation of definitive treatment for cryptococcal meningitis, however further evaluation is needed.
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