Cryptococcal Meningitis Diagnosed With Lumbar Puncture in an Emergency Department Patient With Acute Delirium

Cryptococcal meningitis is a life-threatening fungal infection of the central nervous system. It primarily affects immunocompromised individuals, particularly those with advanced HIV/AIDS, but can occur in people of all ages. Risk factors include solid organ transplantation, hematological malignancies, immunosuppressive medications, and primary immunodeficiency disorders. We describe a case of a 68-year-old male with atypical risk factors for cryptococcal meningitis who presented acutely delirious with a negative diagnostic workup aside from a positive cerebrospinal fluid (CSF) meningitis screen reporting Cryptococcus neoformans/gattii. While the rate of lumbar puncture (LP) in the ED has drastically decreased over the years, we emphasize the importance of considering its diagnostic value in emergency department settings in patients with atypical presentations.