A Case of Cryptococcal Meningitis in a Patient with Alcoholic Cirrhosis and Uncontrolled Diabetes without HIV

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Authors

• Maria Kim, Corewell Health West Resident
• Robert Ocomen, Corewell Health West Resident
• Elizabeth Jakubowski Bustamante, Corewell Health West Resident
• Melanie Mrozek, Corewell Health West Resident
• David Calderhead, Corewell Health West

Description

Cryptococcus meningitis (CM) is a serious infection of the CNS with the majority of infections caused by C. neoformans and C. gatti. It typically presents as a subacute meningoencephalitis with neurologic symptoms. Majority occur in those with HIV/AIDS, but increasing incidence in non-HIV patients has been reported, contributing to at least 20% of CM-related hospitalizations in the US.

A 55-year-old female with alcoholic cirrhosis, uncontrolled type 2 diabetes, bipolar disorder, former smoker presented with four weeks of recurrent falls, ataxia, and slurred speech, along with fever, chills, and headache.  Labs were significant for Na 131, glucose 323, ALP 185, mild transaminitis, PLT 83, HA1c 8.3. Remainder of CBC, CMP, BHB, ammonia, ceruloplasmin, HIV, syphilis, hepatitis panel, drug screen, nutritional and infectious workup were unremarkable. Brain MRI showed abnormal, predominantly leptomeningeal, enhancement greater in the posterior fossa with some involvement in the basal ganglia, thalami, and periventricular regions. Neurology performed LP that showed elevated protein with lymphocytic pleocytosis, cryptococcus antigen 1:160 titer, and positive culture for cryptococcus neoformans/gatti. Blood cryptococcus antigen was negative.

CM most often affects immunocompromised patients, especially those with HIV, but also occurs with glucocorticoid use, transplant, malignancy, sarcoidosis, and hepatic failure. In non-HIV patients, mortality is higher due to atypical presentations, delayed diagnosis, and comorbidities. CM should be kept in the differential for patients with cirrhosis with unexplained altered mental status, as it may mimic hepatic encephalopathy. C. neoformans relies on high-affinity glucose transporters for virulence; uncontrolled diabetes should also be seen as a risk factor for CM.

Publication Date

5-8-2026

Disciplines

Internal Medicine

Recommended Citation

Kim M, Ocomen R, Bustamante E, Mrozek M, Calderhead D. A case of cryptococcal meningitis in a patient with alcoholic cirrhosis and uncontrolled diabetes without HIV. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1977