Fatal cryptococcal meningitis with cerebral cryptococcoma in immunocompetent pregnant woman: a case report.

Cryptococcal meningitis during pregnancy is rare and associated with maternal and fetal morbidity and mortality. Cryptococcus gattii causes disease in individuals without recognized immunosuppression and is associated with severe neurological manifestations. A 27-year-old apparently immunocompetent woman at 11 weeks of gestation, with occupational exposure in animal science and ecotourism, presented with severe headache and progressive neurological deterioration following mild SARS-CoV-2 infection. Initial cerebrospinal fluid (CSF) analysis showed nonspecific lymphomononuclear meningitis, and treatment for herpetic encephalitis was initiated. After 15 days of deterioration, repeat CSF examination revealed encapsulated yeasts, and culture confirmed C. gattii. Amphotericin B deoxycholate and fluconazole were initiated because first-line therapy was unavailable. Despite intensive care, she developed refractory intracranial hypertension associated with cerebral cryptococcoma, fetal demise at 17 weeks, and brain death. This case highlights diagnostic and therapeutic challenges in cryptococcal central nervous system infection during pregnancy and the importance of considering C. gattii in patients without recognized immunosuppression.