skip to main content

Cryptococcal meningitis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectious diseasesCryptococcal meningitisSCE Acute Medicine

A 46-year-old man with HIV not engaged in care presents with two weeks of headache and confusion. Temperature is 37.8°C and he has no neck stiffness. CT head is normal. CD4 count is 38 cells/mm3 and serum cryptococcal antigen is positive. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Perform lumbar puncture to measure opening pressure and confirm cryptococcal meningitis

Subacute headache in advanced HIV with positive cryptococcal antigen strongly suggests cryptococcal meningitis. LP is essential to confirm the diagnosis and measure opening pressure, because raised intracranial pressure is a major cause of morbidity. Starting ART immediately before antifungal control can precipitate immune reconstitution complications.

Reference: BHIVA Opportunistic Infection Guidelines; NICE NG240