A 60-year-old male liver transplant recipient, on immunosuppression, presented with headache, confusion, and ataxia, indicative of severe neurological injury. Initial CSF analysis was negative, but subsequent cultures and India ink stain confirmed Cryptococcus neoformans meningitis, diagnosed after a lumbar puncture. The patient developed hydrocephalus, cerebral edema, and cranial nerve palsies, requiring multiple interventions including ventriculostomy. Despite treatment, he experienced significant neurological sequelae. This case highlights the multifaceted neurological complications that can arise from cryptococcal meningitis in immunocompromised patients, emphasizing the need for high clinical suspicion and prompt diagnosis.
Key note: Cryptococcal meningitis in transplant patients can present with complex and severe neurological injuries beyond typical meningitis symptoms.