A Cryptic Case
Clinical Vignette
A 54-year-old woman with no known immunocompromising condition presents with 3 weeks of progressive headache, nausea, blurry vision, and gait imbalance. She has no history of HIV, transplant, malignancy, or immunosuppressive therapy.
On exam, she is afebrile but has mild sixth-nerve palsy and neck stiffness. Lumbar puncture shows elevated opening pressure, lymphocytic pleocytosis, elevated protein, and low CSF glucose. CSF cryptococcal antigen is positive. HIV testing is negative.
Fungal culture later identifies Cryptococcus spp. Chest imaging does not show findings of pulmonary alveolar proteinosis.
Question
Which host factor is most classically associated with this presentation in an otherwise immunocompetent patient?
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Question 2
In anti-GM-CSF autoantibody-positive CNS cryptococcosis, which Cryptococcus species is most strongly associated?
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References
Wang SY, Lo YF, Shih HP, et al. Cryptococcus gattii Infection as the Major Clinical Manifestation in Patients with Autoantibodies Against Granulocyte-Macrophage Colony-Stimulating Factor. Journal of Clinical Immunology. 2022;42:1730-1741.
Saijo T, Chen J, Chen SCA, et al. Anti-granulocyte-macrophage colony-stimulating factor autoantibodies are a risk factor for central nervous system infection by Cryptococcus gattii in otherwise immunocompetent patients. mBio. 2014;5(2):e00912-14.