This conference used two cases of subacute headache to explore cryptococcal meningitis across different host contexts. The first case involved a young patient with progressive headaches, molluscum contagiosum, weight loss, new neurologic symptoms after steroids, cavitary lung findings, and eventual CNS deterioration, highlighting the importance of recognizing advanced HIV as an underlying risk factor when seemingly disconnected symptoms accumulate.
The teaching portion reviewed Cryptococcus epidemiology, host factors, and exposures, with attention to differences between HIV-associated and non-HIV/non-transplant cryptococcal meningitis. Practical management themes included diagnostic testing, the importance of intracranial pressure control with CSF removal rather than medical therapy, induction and consolidation antifungal treatment, and the difficult question of when to start ART after cryptococcal meningitis.