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Cryptococcal Meningoencephalitis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesCryptococcal MeningoencephalitisRACP Adult Medicine

A 40-year-old HIV-positive man (CD4 50 cells/μL, not on ART) presents with 3 weeks of headache, fever, and neck stiffness. CSF: opening pressure 35 cmH₂O, WCC 15 cells/μL (lymphocytes), protein 1.0 g/L, glucose 1.8 mmol/L. India ink shows encapsulated budding yeast. CSF cryptococcal antigen is positive (titre 1:2048). What is the most likely diagnosis?

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Correct answer: B — Cryptococcal pneumonia

Subacute meningitis in severe immunosuppression (HIV, CD4 <100) with high opening pressure, lymphocytic CSF, low glucose, India ink positive budding yeast, and positive cryptococcal antigen is cryptococcal meningoencephalitis. Treatment per WHO 2024: induction with amphotericin B + flucytosine (1 week), consolidation with fluconazole 800 mg/day (8 weeks), then maintenance fluconazole 200 mg/day. Serial therapeutic LPs for ICP management.

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