Corticosteroids for shunted previously healthy patients with non-HIV cryptococcal meningoencephalitis

Cryptococcal meningoencephalitis (CM) can cause significant morbidity and mortality in previously healthy, non-HIV-infected patients, with all-cause mortality as high as 29% at 1 year.1 Clinical deterioration following microbiological control often results from a postinfectious inflammatory response syndrome (PIIRS). This syndrome may often result in intracranial hypertension (IH) and/or hydrocephalus (HCP).2 Ventricular shunting can provide sustained relief from IH/HCP and improve neurological outcomes.3 However, persistent neurological sequelae, which occur in a subset of patients, may lead to shunt revisions and poor long-term outcomes.3 Corticosteroids have been proposed to improve outcomes in selected, relatively immunocompetent patients with CM, but are often avoided due to presumed immunosuppressive effects.4 5 Paradoxically, the use of corticosteroids during initial therapy of other patient populations such as HIV-associated CM has been found to result in worse overall outcomes.4 We hypothesised that corticosteroid salvage therapy (CST)...

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