Cryptococcal meningitis due to Cryptococcus gattii in an immunocompetent patient: uncommon presentation of a thunderclap headache

BMJ Case Rep. 2022 Apr 4;15(4):e246158. doi: 10.1136/bcr-2021-246158.

Abstract

Thunderclap headache is a medical emergency presented as the worst headache ever, is characterised by an abrupt onset and maximal intensity within seconds to minutes. However, cerebrovascular causes are among the most common causes of thunderclap headache, and other non-vascular life-threatening aetiologies should be considered in evaluating a patient. We describe a 23-year-old previously healthy Latino woman who presented to our hospital after a month of repetitive severe, abrupt-onset headaches. Her prior medical history was unremarkable. After a normal brain MRI with angio-MRI, a lumbar puncture was performed with normal opening pressure, hypoglycorrhachia, increased proteins and a leucocyte; India ink staining was positive for encapsulated yeast, cultures were positive for Cryptococcus gattii The patient received appropriate antifungal treatment with a good response. This case highlights the particular presentation of cryptococcal meningitis due to C. gattii among immunocompetent patients.

Keywords: Cryptococcosis; Infections; Infectious diseases; Meningitis; Neurology (drugs and medicines).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Cryptococcus gattii*
  • Female
  • Headache Disorders, Primary* / etiology
  • Humans
  • Magnetic Resonance Imaging
  • Meningitis, Cryptococcal* / complications
  • Meningitis, Cryptococcal* / diagnosis
  • Meningitis, Cryptococcal* / drug therapy
  • Young Adult

Substances

  • Antifungal Agents