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Cryptococcal Meningitis — RACP Adult Medicine MCQ

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HardInfectious DiseasesCryptococcal MeningitisRACP Adult Medicine

A 30-year-old woman presents with a 2-day history of severe headache, fever, neck stiffness, and photophobia. She is immunosuppressed on mycophenolate. CSF shows WCC 450 cells/µL (70% lymphocytes), protein 1.8 g/L, and glucose 1.0 mmol/L (serum 6.0 mmol/L). India ink preparation is positive. What is the most appropriate treatment?

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Correct answer: A — IV amphotericin B plus flucytosine

Lymphocytic meningitis with low glucose and positive India ink preparation in an immunosuppressed patient indicates cryptococcal meningitis. First-line induction therapy is IV liposomal amphotericin B (3–4 mg/kg/day) plus oral flucytosine (100 mg/kg/day in 4 divided doses) for at least 2 weeks, followed by consolidation with fluconazole 400 mg daily for 8 weeks, then maintenance fluconazole 200 mg daily. Serial lumbar punctures may be needed to manage raised intracranial pressure.

Reference: eTG – 2025 – Antibiotic Guidelines; ATS/IDSA – 2010 – Cryptococcal Disease Guidelines