Case report: fatal dual meningitis with hydrocephalus in HIV-negative woman

A previously healthy 35-year-old woman without HIV developed concurrent tuberculous and cryptococcal meningitis, according to a case report in BMC Infectious Diseases. Her condition deteriorated despite the initiation of antituberculous and antifungal treatment. She developed communicating hydrocephalus with persistently elevated intracranial pressure, then progressed to brain herniation and death. The report documents a single fatal case and cannot establish how frequently the coinfection occurs or how often it is fatal.

The patient initially experienced prolonged constitutional symptoms, including fever, weight loss and malaise. These symptoms were followed by progressive neurological deterioration, with headache, altered mental status and signs of raised intracranial pressure. The report notes that tuberculous meningitis and cryptococcal meningitis have overlapping clinical features, creating diagnostic and therapeutic challenges when both infections are present.

Cerebrospinal fluid analysis supported a dual diagnosis. A positive GeneXpert result identified Mycobacterium tuberculosis, while cryptococcal antigen testing was consistent with Cryptococcus neoformans infection. The patient was described as HIV-negative and had no known immunosuppressive condition. The report characterizes simultaneous central nervous system infections caused by these pathogens as exceedingly rare, particularly in immunocompetent individuals.

Following diagnosis, appropriate antituberculous therapy and antifungal treatment were initiated. Nevertheless, the woman’s clinical condition continued to worsen. The case report does not provide sufficient information in the supplied account to determine whether a particular treatment regimen, the concurrent infections or other factors contributed to the fatal outcome. It therefore should not be read as evidence that either infection was untreatable or that any specific treatment caused the outcome.

During the clinical course, the patient developed communicating hydrocephalus, accompanied by intracranial pressure that remained elevated. Her neurological deterioration ultimately progressed to brain herniation and death. Hydrocephalus and raised intracranial pressure are therefore documented features of this presentation, but the supplied report does not detail the imaging or clinical measurements used to characterize them.

The authors emphasize the need for a high index of suspicion for dual infections in settings where tuberculosis and cryptococcosis occur. The case illustrates that symptoms compatible with either form of meningitis may accompany coinfection, making laboratory evidence important for establishing the diagnosis. In this patient, cerebrospinal fluid testing supported the presence of both pathogens rather than a single infectious cause.

The report also identifies multidisciplinary management and timely neurosurgical intervention as potentially important in cases accompanied by hydrocephalus and raised intracranial pressure. This is presented as a general implication of the case, not as evidence that a particular coordinated team or intervention was delivered in this patient. The supplied account does not establish the timing, type or outcome of any neurosurgical procedure.

As a single-patient case report, the research has a narrow evidentiary scope. It cannot determine the incidence of concurrent tuberculous and cryptococcal meningitis, identify the immune mechanisms or predisposing factors that permit coinfection, or compare management strategies. Its principal reported value is to document severe dual CNS infection with fatal hydrocephalus in an HIV-negative patient without a known immunosuppressive condition, while showing the diagnostic difficulty created by overlapping clinical features.

Subject of Research: Fatal concurrent tuberculous and cryptococcal meningitis with hydrocephalus in an HIV-negative patient

Article Title: Concurrent tuberculous and cryptococcal meningitis with hydrocephalus in an HIV- negative patient: a fatal case report

Article References: Tesfaye, M. Z., Gebretekle, F. T., Mered, E. F., Talemahu, A. A., & Kassie, H. T. (2026). Concurrent tuberculous and cryptococcal meningitis with hydrocephalus in an HIV- negative patient: a fatal case report. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14455-4

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14455-4

Keywords: tuberculous meningitis, cryptococcal meningitis, concurrent infections, HIV-negative patient, hydrocephalus, intracranial pressure, cerebrospinal fluid, case report, Concurrent, tuberculous, cryptococcal, meningitis