Cryptococcal Meningitis in an HCV-Positive and IVDU- and HIV-Negative Patient: A Case Report and Literature Review

Heiler Lozada-Ramos,1– 3 Jorge Álvarez-Payares,4 Jorge Enrique Daza-Arana,2,5 Luisa María Salas-Marín4 1Medicine Program, School of Health, Universidad Santiago de Cali, Palmira, Colombia; 2Movement and Health Research Group, School of Health, Universidad Santiago de Cali, Santiago de Cali, Colombia; 3Doctoral Program in Infectious Diseases, Universidad de Santander – UDES, Bucaramanga, Colombia; 4Medicine Program, School of Health, Universidad del Valle, San Fernando Campus, Santiago de Cali, Colombia; 5Physiotherapy Program, School of Health, Universidad Santiago de Cali, Cali, ColombiaCorrespondence: Heiler Lozada-Ramos, Email [email protected]: Cryptococcal meningitis (CM) is a central nervous system (CNS) infection that occurs mainly in immunocompromised individuals such as those with human immunodeficiency virus (HIV) infection. However, the prevalence of CM in immunocompetent patients has increased. Although CM has been reported in patients with hepatitis C virus (HCV) infection, it has not yet been fully established whether there is an association between both conditions. CM has also been reported in patients with intravenous drug use (IVDU), which is related to the immunosuppression caused by these drugs.Case Presentation: We report the case of a 24-year-old man who presented with meningitis secondary to Cryptococcus gattii infection. He had a history of IVDU and HCV infection, was HIV-negative and without antiviral treatment. The patient received adequate antifungal treatment during induction, consolidation, and maintenance phases. His condition relapsed, requiring dose adjustment, with an excellent response during clinical follow-up for both meningitis and HCV infection. A brain biopsy was requested during relapse to rule out other co-infection.Conclusion: The case of an individual diagnosed with cryptococcal meningitis, who had a history of IVDU and HCV infection, is presented. The coexistence of such events could shadow the prognosis of this group of subjects, related to immunosuppression that can be caused through different pathways. Having HCV and being a IVDU simultaneously could increase the risk of Cryptococcus infection.Keywords: hepatitis C, cryptococcal meningitis, HIV infection, cryptococcosis, intravenous drug use