Acute Ischemic Stroke Revealing Cryptococcal Meningitis in an HIV-infected Patient with a Relatively Preserved CD4 Count: a Case Report.

Cryptococcal meningitis (CM) is one of the most devastating opportunistic infections in people living with HIV and typically occurs in patients with advanced immunosuppression. Ischemic stroke is an uncommon manifestation and rarely represents the initial presentation. We report a 28-year-old man with an 11-year history of HIV infection who presented with acute right-sided hemiparesis despite a relatively preserved CD4 count (302 cells/mm³). Brain magnetic resonance imaging demonstrated an acute infarction of the left internal capsule with communicating hydrocephalus. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, elevated protein, low glucose, positive cryptococcal antigen, and culture-confirmed Cryptococcus neoformans. The patient was treated with amphotericin B and fluconazole, resulting in marked clinical improvement. This case demonstrates that CM may present as acute ischemic stroke in HIV-infected patients despite a relatively preserved CD4 count and the absence of classical meningeal manifestations. Early cerebrospinal fluid evaluation and prompt antifungal therapy are essential to avoid delayed diagnosis and improve neurological outcomes.