<i>Cryptococcus gattii</i>in an Immunocompetent Patient in the Southeastern United States

Abstract

Cryptococcal infections are seen throughout the United States in both immunocompromised and immunocompetent patients. The most common form is <i>C. neoformans</i>. In the Northwestern United States, <i>C. gattii</i> has received considerable attention secondary to increased virulence resulting in significant morbidity and mortality. There are no cases in the extant literature describing a patient with <i>C. gattii</i> requiring neurosurgical intervention in Alabama. A middle-aged immunocompetent male with no recent travel or identifiable exposure presented with meningitis secondary to <i>C. gattii</i>. The patient underwent 12 lumbar punctures and a ventriculoperitoneal shunt and required 83 days of inpatient therapy with 5-flucytosine and amphotericin B. The patient was found to have multiple intracranial lesions and a large intramedullary spinal cryptococcoma within his conus. Following an almost 3-month hospitalization the patient required treatment with oral voriconazole for one year. In the United States meningitis caused by <i>C. gattii</i> infection is not isolated to the Northwestern region.