Cryptococcal Meningitis in Pregnancy, the Neglected Diagnosis: A Case Report

Abstract

Introduction: Cryptococcal meningitis is an opportunistic infection of human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) that can cause maternal and fetal mortality and morbidity. This case report aims to help clinicians to consider it as a differential diagnosis in HIV-seropositive pregnant women presenting with vague symptoms. This is particularly important as HIV/AIDS is now a global pandemic. There is a test available for disease surveillance.
Case Report: A 31-year-old P3 G4 HIV seropositive patient on antiretroviral therapy/cotrimoxazole presented at 29 weeks gestation by dates complaining of draining clear fluid per vagina for 24 hours, slight frontal headache and vomiting. On admission, she was ill-looking but was apyrexial with a body temperature of 36.2 °C. A sterile speculum examination confirmed ruptured membranes with a pool of liquor in the posterior vaginal fornix. She was treated as a case of preterm pre-labour rupture of membranes. Therapy consisted of erythromycin and dexamethasone. She complained of increasing frontal headaches and vomiting and on detailed examination was found to be now having neck stiffness. A lumbar puncture was performed and microscopy showed Cryptococcus neoformans. She was managed by a multidisciplinary team involving physicians and was treated with antifungals. She delivered prematurely by normal vaginal delivery a baby boy weighing 2100 g with Apgar 7 and 9 scores at 1 and 5 minutes respectively. Post-partum she continued to fit for a day but subsequently the convulsions stopped and the patient began to improve clinically.
Conclusion: There is need to raise awareness amongst clinicians about serious opportunistic infections in HIV infected pregnant mothers for early diagnosis and treatment. Antifungal therapy can be life-saving and prevent maternal deaths.