Abstract
Cryptococcal meningitis remains a significant opportunistic infection in people living with human immunodeficiency virus (HIV), occurring with advanced immunosuppression. We report the case of a 59-year-old HIV-type-1-positive man, previously with an undetectable viral load and a CD4+ count of 504 cells/μL, who presented with altered mental status and right-sided ptosis. He had missed follow-up for one year, and repeat testing showed a CD4+ count of 218 cells/μL and a viral load of 258,000 copies/mL. Brain MRI revealed leptomeningeal enhancement of the basal cisterns. Cerebrospinal fluid analysis confirmed Cryptococcus spp. The patient completed induction therapy with amphotericin B and flucytosine, with marked neurological improvement. Antiretroviral therapy (ART) was resumed after stabilization, and consolidation therapy with fluconazole was initiated. This case highlights an atypical presentation of cryptococcal meningitis, with CD4+ count above 100 cells/μL, and underscores the importance of ART adherence and prompt investigation of subacute neurological symptoms in HIV-infected individuals.