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Cryptococcal Meningitis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesCryptococcal MeningitisRACP Adult Medicine

A 45-year-old HIV-positive man (CD4 80 cells/μL) presents with 2 weeks of headache and confusion. CSF: Opening pressure 35 cmH₂O, WCC 25 cells/μL (90% lymphocytes), protein 1.2 g/L, glucose 2.0 mmol/L. India ink shows encapsulated yeast. Cryptococcal antigen is positive (titre 1:1024). What is the most likely CSF diagnosis?

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Correct answer: A — Cryptococcal meningitis

Subacute meningitis in HIV with low CD4, very high opening pressure, lymphocytic pleocytosis, low glucose, and positive India ink/cryptococcal antigen is cryptococcal meningitis. Treatment is amphotericin B plus flucytosine induction (2 weeks), fluconazole consolidation (8 weeks), then fluconazole maintenance. Therapeutic lumbar punctures for raised ICP management.

Reference: eTG Antibiotic – 2025 – Cryptococcal Meningitis; WHO 2024 Crypto Guidelines