Cryptococcal meningitis and anti NMDA antibodies in an immunocompetent patient

Background: Cryptococcal meningitis is the most common cause of fungal meningitis, frequently seen in an immunocompromised state. The concomitant presence of cryptococcal meningitis and anti-NMDA receptor antibodies is a new and rare occurrence and the pathophysiology behind the co-occurrence of two has not yet been fully elucidated. To the best of our knowledge, four cases have been reported in the literature so far. Case presentation: We herein report another case of a 56-year-old lady who presented to the emergency with dysarthria, left-sided weakness, and altered sensorium. Case report: MR imaging of the brain revealed hyperintense signals in the cortical and subcortical areas. CSF showed lymphocytic predominance. Cryptococcal antigen and anti-NMDA receptor antibody came out to be positive. Our patient gradually improved on steroids and Fluconazole therapy. Conclusion: Whether the cryptococcal infection is related to brain autoimmunity or is a trigger to the development of anti-NMDA receptor antibodies is still ambiguous and is yet to be uncovered. Nevertheless, all immunocompetent patients with cryptococcal meningitis should be tested for anti-NMDA receptor antibodies and further studies are required to attain a better understanding and to explore treatment options.