Transient loss of consciousness caused by cryptococcal meningitis in an immunocompetent patient: a case report

An immunocompetent 51 year-old female presented to the Emergency Department (ED) with a chief complaint of transient loss of consciousness and was found to have cryptococcal meningitis. She complained of general fatigue and a 'cramping' sensation in her right arm for one week. The physical exam was significant for the presence of a right homonymous hemianopsia and the absence of fever or signs of meningismus. A computed tomography (CT) of the brain was interpreted as showing an age-indeterminate infarct in the left parietal region. However, a magnetic resonance imaging (MRI) of the brain showed multiple areas of meningeal enhancement. Cerebrospinal fluid analysis revealed a positive cryptococcal antigen and 105 white blood cells. The patient was successfully treated with Amphotericin B and fluconazole. While cryptococcal meningitis is typically a disease of the immunocompromised, it can, as in this case, present in an immuncompetent host.