Cryptococcus meningitis and skin lesions in a HIV negative child.

Abstract

Disseminated Cryptococcosis is an uncommon occurrence in immunocompetent populations and occurs mainly in immunocompromised patients. We describe the first reported case of Cryptococcus meningitis and skin lesions in a 4 year old confirmed HIV negative boy who presented with fever, meningism and skin lesions. On examination he was confused, uncooperative, had neck stiffness and raised skin lesions. A septic screen, including skin scraping, was performed and he was on an empiric stat dose of Penicillin and Ceftriaxone for suspected meningococcal meningitis. The cerebrospinal fluid revealed normal protein, glucose and chloride levels; yeasts were observed on Gram stain from the CSF and skin scraping. The India ink stain and Cryptococcus neoformans latex agglutination test on the CSF were both positive. Bacterial culture of the skin biopsy, CSF and blood culture specimens was negative. He was treated with Amphotericin B based on preliminary results and had a gradual, recovery with no neurological sequelae. He continued oral Fluconazole.