An Unusual Presentation of Postural Headache Caused by Cryptococcus neoformans Meningitis in an Elderly Person

Summary 

Headache is a common complaint in the emergency department (ED). It is crucial and challenging for ED physicians to differentiate life-threatening causes from benign ones. We present a 64-year-old male who attended our ED suffering from dizziness and elevated blood pressure for the previous 2 days. He had also suffered from headache during the 2 weeks prior to his presentation at the ED. The patient had a medical history of hypertension and hepatitis B. After a thorough investigation, including a cerebrospinal fluid (CSF) analysis, his blood and CSF showed high titers of Cryptococcus. Empirical antifungal antibiotics were given after the CSF analysis. After 50 days of amphotericin B and fluconazole therapy, he was discharged with oral fluconazole (400mg/day) and followed up in the outpatient department.

Key Words:  chronic meningitis , cryptococcal meningitis , headache , immunocompetent

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