Cryptococcal Meningoencephalitis With Herpes Zoster Coinfection in a Retrovirus-Positive Adolescent Male With a Normal CD4 Count: A Rare Case

Cryptococcal meningoencephalitis is a grave and lethal form of an opportunistic infection usually occurring in immunocompromised patients (i.e., those with AIDS, organ transplant recipients, or those on immunosuppressive therapy) caused by <i>Cryptococcus</i> species, namely <i>Cryptococcus neoformans,</i> which has a worldwide distribution, or <i>Cryptococcus gattii,</i> which is predominantly found in tropical, subtropical, and temperate regions. <i>Cryptococcus</i> species are usually found in soil contaminated with bird or animal droppings in the form of cryptococcal spores. The former occurs predominantly in immunocompromised patients, affecting the central nervous system (CNS), while the latter occurs in immunocompetent patients, affecting the pulmonary system predominantly. Transmission occurs through these spores, which subsequently disseminate to the CNS through the hematogenous route. Manifestations include fever, headache, nausea, altered mental status, and meningismus in certain cases, potentially advancing to neurological problems such as elevated intracranial pressure, blindness, and seizures. Presentation in immunocompetent individuals is indolent, so diagnosis and treatment are delayed. Timely diagnosis and immediate treatment are essential to avert complications and mortality. Over the past few years, cryptococcal infection has seen an upward trend globally. Despite the availability of antifungal therapy, it has emerged as a significant public health concern, rendering it a therapeutically challenging case. Moreover, infrequent coinfections with bacteria or viruses might complicate therapy and prognosis. We hereby report a rare case of cryptococcal meningoencephalitis with herpes zoster coinfection occurring in an HIV patient with a normal CD4 count.