A case of severe meningoencephalitis co-infection due to Cryptococcus neoformans and Treponema pallidum in an HIV-positive patient

Cryptococcal meningitis and neurosyphilis are rare diseases in Europe. Coinfection of the nervous system by two distinct non-viral organisms is uncommon and frequently undiagnosed. Differential diagnosis suggests that a single pathologic process should be sought. However, in the presence of severe immunodeficiency, this approach may not be accurate. In the literature, there have been described only one case of Cryptococcus neoformans and Treponema pallidum coinfection affecting nervous system. We report a case of 30-years-old man admitted to a local hospital due to symptoms of meningitis. On admission, the immunological and viral status of the patient was unknown. It led to delayed diagnosis, as cerebrospinal fluid (CSF) results were unspecific. Eventually, Cryptococcus neoformans was detected in CSF. He was referred to Department of Infectious Diseases of Poznan University of Medical Sciences, where a full panel of tests was performed and confirmed HIV infection, cryptococcal meningitis, and neurosyphilis. The patient was put on antiretroviral therapy (ART), ceftriaxone, and amphotericin B. Magnetic resonance imaging revealed an encephalitis. After an aggressive therapy, patient has become stable, and on a frequent follow-up schedule in the outpatient setting.

The reported case is extremely rare. Diagnosed coinfection shows the importance of considering many etiologic possibilities, when an immunocompromised patient presents to an emergency room. Clinicians need to consider Cryptococcus neoformans and syphilis in the differential diagnosis of neurological disorders, particularly aseptic meningitis, as early diagnosis and treatment lead to a better prognosis.