Cryptococcal Meningitis Confounded by Concurrent Cytomegalovirus Viraemia in a Renal Transplant Recipient: A Diagnostic Challenge

Cryptococcal meningitis is a well-recognized opportunistic infection in immunocompromised patients, especially in transplant recipients receiving immunosuppressive therapy. Concurrent cytomegalovirus (CMV) viraemia is uncommon and can make the clinical picture misleading. We report a renal transplant recipient who presented with fever, headache, and generalized malaise. He was initially diagnosed with CMV viraemia and started on valganciclovir. However, his condition later worsened, and he developed seizures. Further investigation revealed cryptococcal meningitis, confirmed by cerebrospinal fluid culture. This case highlights the need for a high index of suspicion in immunosuppressed patients. It also emphasizes the importance of considering dual opportunistic infections when symptoms persist or worsen despite appropriate treatment.