Cryptococcal Meningitis in Acute Onset Psychosis: A Case-Study

Abstract

Introduction

Cryptococcal meningitis is a frequently observed opportunistic infection in patients with late-stage HIV-infection, especially among people living in South-East Asia and Central Africa. The worldwide incidence is estimated at one million cases. The worldwide mortality of HIV-associated cryptococcal meningitis remains high (10–30%), due to the inadequacy of antifungal treatments and complications of increased intracranial pressure. Clinical symptoms of cryptococcal meningitis are fever, headache, vomiting, and altered mental status. Neck stiffness, papiledema, and focal neurological symptoms are sometimes present.

Objectives

We describe the case of a patient who first developed a delirium, and a few months later an acute-onset psychosis, after a past cryptococcal infection.

Aims

To report a case-study describing acute-onset psychosis as a neuropsychiatric consequence of HIV-infection.

Methods

A case-study is presented and discussed, followed by a literature review.

Results

A 49-year-old African-born male was admitted to hospital with an acute psychosis. He had been treated by an internist after being found to have HIV. As a result of non-compliance over a period of about four months, his cd4-count had dropped to 40. Six months earlier he had developed cryptococcal meningitis, which left him a number of neurological and psychiatric symptoms. During his stay in hospital, there had to be good collaboration with the specialist in internal medicine whose dual task was to manage the patient's dramatically low cd4-count as well as his psychosis.

Conclusion

Cryptococcal meningitis is a risk factor for psychiatric disorders and mortality in HIV-infected persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.