A 56-year-old male, previously treated with cladribine for multiple sclerosis, presented with chronic Cryptococcus neoformans meningitis over four years, ultimately proving fatal. His initial symptoms included headache, nausea, and visual disturbances, which progressed despite various antifungal treatments. Diagnosis was confirmed by microscopy and culture of cerebrospinal fluid, identifying Cryptococcus neoformans. The prolonged course and treatment resistance highlight the challenges in managing cryptococcal infections in immunocompromised patients, especially those with T-cell depletion from cladribine. This case underscores the importance of considering opportunistic infections in patients on immunosuppressive therapies, even years after treatment cessation.
Key note: Chronic cryptococcal meningitis can have a protracted and fatal course in patients with cladribine-induced immunosuppression, necessitating high clinical suspicion and aggressive management.