Cryptococcal Meningitis with Cerebral Herniation

Cryptococcus neoformans (C. neoformans var. grubii and C. neoformans var. neoformans) and C. gattii are responsible for most cases of cryptococcal meningitis worldwide [1]. The disease of cryptococcal meningitis has been well documented in patients with acquired immune deficiency syndrome (AIDS) and it may also occur in human immunodeficiency virus (HIV)-negative patients even with apparently normal immune systems [2,3]. The median age of 38.5 years at presentation in the non-HIV patients is similar to that in the HIV population (median age, 36 years) [2,4]. Chinese population seems to be more vulnerable than other ethnic groups to cryptococcal meningitis in the previously healthy patients [5]. However, the diagnosis is easily delayed and the disease manifestations may be more severe in cryptococcal meningitis of the immunocompetent patients than in immunocompromised patients [4]. The most common underlying condition in Chinese patients with cryptococcal meningitis is corticosteroid use [4], which has sometime been added illegally to traditional herb drug medication.