Title : Disseminated cryptococcosis with concurrent pneumocystis jirovecii pneumonia in newly diagnosed advanced HIV complicated by refractory raised intracranial pressure Requiring external ventricular drainage
Abstract:
Background: Disseminated cryptococcosis remains a major opportunistic infection in advanced HIV and is associated with significant morbidity and mortality.
Case Presentation: A 27-year-old man with newly diagnosed HIV infection (CD4 count 9 cells/µL; viral load 920,000 copies/mL) presented with constitutional symptoms, headache and respiratory complaints. CT thorax demonstrated bilateral diffuse ground-glass opacities consistent with Pneumocystis jirovecii pneumonia. Blood cultures and CSF analysis confirmed disseminated Cryptococcus neoformans infection with cryptococcal meningitis and an opening pressure of 40 cm H?O. Despite serial lumbar punctures, he developed refractory intracranial hypertension requiring intensive care admission, mechanical ventilation and external ventricular drain insertion. Following antifungal therapy and delayed antiretroviral initiation, he developed cryptococcal IRIS which responded to corticosteroids.
Conclusion: This case highlights the challenges of managing concurrent opportunistic infections in advanced HIV and emphasises the importance of aggressive intracranial pressure management, multidisciplinary care and careful timing of antiretroviral therapy.
