We present a rare case of Candida Dubliniensis meningitis in a young immunocompetent host who experienced symptoms for 2 years leading up to admission.
C. Dubliniensis is a predominantly opportunistic pathogen that can cause invasive and fatal disease in an immunocompromised host. The diagnosis of candida as a cause of chronic meningitis is often challenging and may be delayed by negative CSF culture finings. In the present case, repeated CSF cultures and polymerase chain reaction (PCR) were negative before definitive diagnosis was made. The diagnostic challenge in this case may explain the limited number of cases in immunocompetent patients within the literature.
A 22-year-old immunocompetent female presented with a diagnosis of bacterial meningitis. Two years prior, she received extracorporeal membrane oxygenation (ECMO) for Covid-19 complicated by myocarditis. Following discharge, she reported headaches of increasing intensity, all refractory to treatments. Brain magnetic resonance imaging (MRI) was inconclusive at the time. Now, she was admitted for worsening headaches with cranial nerve VI palsy. Lumbar puncture (LP) revealed white blood cell count (WBC) of 166 cells/µL with neutrophilic predominance and her symptoms progressed, despite 5 days of treatment with broad spectrum antibiotics. All cultures returned negative. Repeat LP revealed 835 WBC/mm3, 225 mg/dL protein, and 4 mg/100 mL glucose. Brain MRI revealed nodular enhancement in the brainstem and communicating hydrocephalus. MRI of the lumbar spine revealed meningeal enhancement. Repeat CSF cultures came back positive for C. Dubliniensis. Treatment began with Amphotericin B and Flucytosine.