Refractory Cryptococcus neoformans Meningoencephalitis in an
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This article presents a case of refractory Cryptococcus neoformans meningoencephalitis in an immunocompetent woman. Her clinical symptoms did not improve with 6 months of antifungal therapy and MRI abnormalities, indicating severe meningeal and cerebral inflammation, persisted despite a decreasing cryptococcal antigen titer. The patient continued to deteriorate despite antifungal therapy and her condition clearly improved following treatment with adjunctive corticosteroid.

Authors postulate that the paradoxical antifungal therapy-related clinical deterioration was due to an immune response to cryptococcal organisms, which responded to corticosteroids. These observations provide a rationale for a further evaluation of corticosteroids in the management of select cases of C. neoformans central nervous system infection.

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