The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report
Cryptococcal meningitis is one of the major causes of death in sub-Saharan Africa among individuals with advanced HIV, and it is typically diagnosed through lumbar puncture (LP). However, LP may be contraindicated in some cases, causing a clinical dilemma and potential delay in treatment. We present...
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Elsevier
2025-06-01
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| Series: | Medical Mycology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211753925000090 |
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| author | Asmus Tukundane Richard Kwizera Lillian Tugume Jayne Ellis David R. Boulware David B. Meya |
| author_facet | Asmus Tukundane Richard Kwizera Lillian Tugume Jayne Ellis David R. Boulware David B. Meya |
| author_sort | Asmus Tukundane |
| collection | DOAJ |
| description | Cryptococcal meningitis is one of the major causes of death in sub-Saharan Africa among individuals with advanced HIV, and it is typically diagnosed through lumbar puncture (LP). However, LP may be contraindicated in some cases, causing a clinical dilemma and potential delay in treatment. We present the case of a 60-year-old female, newly diagnosed with HIV, who presented with a reduced level of consciousness and a positive serum cryptococcal antigen (CrAg) test (high titer = 1:320). Computerized tomographic (CT) brain imaging showed multiple nodular lesions, peri-lesional edema and a midline shift. Despite the contraindication for LP, a low volume lumbar puncture (1–2 mL) was performed in view of the elevated serum CrAg titers and patient's clinical symptoms, in order to rule in a definitive diagnosis of cryptococcal meningitis or exclude tuberculous meningitis. The patient was treated for cryptococcal meningitis and responded well. In patients with a positive serum CrAg test and contraindications to LP, an elevated titer (>1:160) and neurological symptoms may guide the initiation of definitive treatment for cryptococcal meningitis, however further evaluation is needed. |
| format | Article |
| id | doaj-art-387f401754f04e41b3f9cff21727aba8 |
| institution | OA Journals |
| issn | 2211-7539 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Medical Mycology Case Reports |
| spelling | doaj-art-387f401754f04e41b3f9cff21727aba82025-08-20T02:06:20ZengElsevierMedical Mycology Case Reports2211-75392025-06-014810070010.1016/j.mmcr.2025.100700The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case reportAsmus Tukundane0Richard Kwizera1Lillian Tugume2Jayne Ellis3David R. Boulware4David B. Meya5Corresponding author. Department of Research, Infectious Diseases Institute College of Health Sciences, Makerere University P.O.BOX 22418, Kampala, Uganda.; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaCryptococcal meningitis is one of the major causes of death in sub-Saharan Africa among individuals with advanced HIV, and it is typically diagnosed through lumbar puncture (LP). However, LP may be contraindicated in some cases, causing a clinical dilemma and potential delay in treatment. We present the case of a 60-year-old female, newly diagnosed with HIV, who presented with a reduced level of consciousness and a positive serum cryptococcal antigen (CrAg) test (high titer = 1:320). Computerized tomographic (CT) brain imaging showed multiple nodular lesions, peri-lesional edema and a midline shift. Despite the contraindication for LP, a low volume lumbar puncture (1–2 mL) was performed in view of the elevated serum CrAg titers and patient's clinical symptoms, in order to rule in a definitive diagnosis of cryptococcal meningitis or exclude tuberculous meningitis. The patient was treated for cryptococcal meningitis and responded well. In patients with a positive serum CrAg test and contraindications to LP, an elevated titer (>1:160) and neurological symptoms may guide the initiation of definitive treatment for cryptococcal meningitis, however further evaluation is needed.http://www.sciencedirect.com/science/article/pii/S2211753925000090Cryptococcal meningitisLumbar punctureSerum CrAgCrAg titersFungal diagnostics |
| spellingShingle | Asmus Tukundane Richard Kwizera Lillian Tugume Jayne Ellis David R. Boulware David B. Meya The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report Medical Mycology Case Reports Cryptococcal meningitis Lumbar puncture Serum CrAg CrAg titers Fungal diagnostics |
| title | The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report |
| title_full | The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report |
| title_fullStr | The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report |
| title_full_unstemmed | The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report |
| title_short | The diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated: A case report |
| title_sort | diagnostic role of elevated serum cryptococcal antigen titers in patients with suspected cryptococcal meningitis when lumbar puncture is contraindicated a case report |
| topic | Cryptococcal meningitis Lumbar puncture Serum CrAg CrAg titers Fungal diagnostics |
| url | http://www.sciencedirect.com/science/article/pii/S2211753925000090 |
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