{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T21:21:19Z","timestamp":1773523279305,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Direcci\u00f3n General de investigaciones of Universidad Santiago de Cali","award":["DGI-01-2025"],"award-info":[{"award-number":["DGI-01-2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Central nervous system (CNS) cryptococcosis caused by Cryptococcus neoformans is a severe opportunistic infection that primarily affects individuals with impaired cellular immunity. Although the classic presentation includes headache, fever, and meningeal signs, chronically immunosuppressed patients may develop atypical neuropsychiatric manifestations, leading to diagnostic delays. We report the case of a 53-year-old man with rheumatoid arthritis (RA) receiving long-term prednisolone and etanercept therapy, who presented with a 7-day history of depressive mood, anhedonia, social withdrawal, irritability, and progressive confusion. Neurological examination revealed disorientation without focal deficits. Brain imaging showed only mild cortical atrophy, and cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, low glucose, and elevated protein levels. Multiplex PCR (FilmArray\u00ae) of CSF identified Cryptococcus neoformans, CSF positive to C. neoformans. The patient was treated with liposomal amphotericin B followed by fluconazole, resulting in gradual improvement of both neurological and psychiatric symptoms. This case highlights an unusual presentation of CNS cryptococcosis in a non-HIV immunosuppressed patient with RA, emphasizing that acute psychiatric or cognitive changes can be the predominant manifestation. Clinicians should consider fungal infections in the differential diagnosis of acute neuropsychiatric symptoms in patients receiving chronic corticosteroid and biologic therapy. Early recognition and molecular diagnosis can facilitate timely antifungal treatment, potentially improving prognosis and reducing morbidity associated with delayed therapy. This report underscores the importance of awareness of atypical presentations of opportunistic infections in immunosuppressed populations.<\/jats:p>","DOI":"10.3390\/diseases13120404","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:32:27Z","timestamp":1765960347000},"page":"404","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unusual Neuropsychiatric Presentation of Cryptococcus neoformans Meningoencephalitis in an Immunosuppressed Patient with Rheumatoid Arthritis: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5656-9418","authenticated-orcid":false,"given":"Sinthia","family":"Vidal-Ca\u00f1as","sequence":"first","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Salud Integral (GISI), Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-2439","authenticated-orcid":false,"given":"Manuel David","family":"Mayoral-Valencia","sequence":"additional","affiliation":[{"name":"Facultad de Salud, Universidad Tecnol\u00f3gica de Pereira (UTP), Pereira 660005, Colombia"},{"name":"Facultad de Salud, Universidad del Valle, Cali 760035, Colombia"},{"name":"Facultad de Salud, Pontificia Universidad Javeriana, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2616-6306","authenticated-orcid":false,"given":"Esteban","family":"Artunduaga-Ca\u00f1as","sequence":"additional","affiliation":[{"name":"Facultad de Salud, Unidad Central del Valle del Cauca (UCEVA), Tul\u00faa 763021, Colombia"},{"name":"Grupo de Investigaci\u00f3n en Gen\u00e9tica, Fisiolog\u00eda y Metabolismo (GEFIME), Ciencias de la Salud, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esteban","family":"Pineda-Arias","sequence":"additional","affiliation":[{"name":"Semillero de Enfermedades Infecciosas Transmisibles (EINTRANS), Facultad de Salud, Unidad Central del Valle, Tulu\u00e1 763021, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danna Alejandra Betancourt","family":"Ca\u00f1as","sequence":"additional","affiliation":[{"name":"Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5914-0601","authenticated-orcid":false,"given":"Daniela","family":"Arturo-Terranova","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Gen\u00e9tica, Fisiolog\u00eda y Metabolismo (GEFIME), Ciencias de la Salud, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Beardsley, J., Sorrell, T.C., and Chen, S.C.-A. 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Dis."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/12\/404\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:04:11Z","timestamp":1765962251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/12\/404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["diseases13120404"],"URL":"https:\/\/doi.org\/10.3390\/diseases13120404","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]}}}