Mycobacterium tuberculosis and Cryptococcus neoformans co-infection meningitis in a young immuncompetent woman

Objectives: Meningitis is a severe and potentially fatal form of tuberculosis. The diagnostic workup involves detection of acid-fast bacilli (AFB) in the cerebrospinal fluid (CSF) by microscopy or culture. However, the difficulty in detecting the organism poses a challenge in diagnosis. Cryptococcosis is an opportunistic fungal infection caused by cryptococcus neoformans. We presented central nervous system co-infection of tuberculosis and Cryptococcus neoformans which is extremely rare. Patient: The patient was a 35 year-old woman who was admitted in hospital due to fever, headache and changes of mental status. Physical examination revealed neck stiffness and positive Kernig’s and Brudsinsky’s signs. Cerebrospinal fluid analysis showed lymphocytic pleocytosis and culture of cerebrospinal fluid revealed mycobacterium tuberculosis and cryptococcus neoformans. Conclusion: Tuberculosis meningitis should be considered in patients with chronic meningitis especially in endemic areas. Cryptococcus neoformans meningitis may occur in immunocompromised and immuncompetent patients. Central nervous system co-infection with tuberculosis and Cryptococcus neoformans is possible.