Concurrent tuberculous and cryptococcal meningitis with hydrocephalus in an HIV- negative patient: a fatal case report

Concurrent central nervous system infections caused by Mycobacterium tuberculosis and Cryptococcus neoformans are exceedingly rare, particularly in HIV-negative (Human Immunodeficiency Virus) immunocompetent individuals, and present significant diagnostic and therapeutic challenges due to overlapping clinical features. We report the case of a previously healthy 35-year-old woman who presented with prolonged constitutional symptoms, including fever, weight loss, and malaise, followed by progressive neurological deterioration with headache, altered mental status, and signs of raised intracranial pressure. Cerebrospinal fluid (CSF) analysis was consistent with a dual infection, with a positive GeneXpert result for Mycobacterium tuberculosis and cryptococcal antigen testing consistent with Cryptococcus neoformans . Despite initiation of appropriate anti-tuberculous therapy and antifungal treatment, her clinical condition deteriorated. She developed communicating hydrocephalus with persistently elevated intracranial pressure, ultimately progressing to brain herniation and death. This case highlights the rare but severe occurrence of concurrent tuberculous meningitis (TBM) and cryptococcal meningitis (CM) in an HIV-negative patient with no known immunosuppressive condition, and underscores the importance of maintaining a high index of suspicion for dual infections in endemic settings. Early diagnosis and aggressive multidisciplinary management, including timely neurosurgical intervention, may play an important role in improving patient outcome.