Coexisting cryptococcal and tuberculous meningitis with glial fibrillary acidic protein antibody positivity in chronic lympho-cytic leukemia:expanding the spectrum of infection-immunity interplay
Jinli Feng
Ming Fang
Shuang Wang
Jun Zhao
Xuling Wang
Zhuangzhuang Ren
Jinming Han
Feng Qiu
Abstract：Background Immunocompromised individuals are susceptible to Cryptococcus and Mycobacterium tuberculosis infections. Coinfection can complicate diagnosis, and both may cause cerebral infarction. No previous reports describe cases of cryptococcal meningitis (CM) or tuberculous meningitis (TBM) with cerebrospinal fluid (CSF) testing positive for glial fibrillary acidic protein (GFAP) antibodies.
Methods We present the case of a 60-year-old man with chronic lymphocytic leukemia, initially diagnosed with TBM, who developed cerebral infarction and was found to test positive for CSF GFAP antibodies, later confirmed as CM. A focused literature review was performed for cases involving CM/TBM coinfection, cerebral infarction, and GFAP antibody positivity.
Results This case highlights overlapping clinical and imaging features of CM and TBM, including basal ganglia and thalamic infarctions. CSF GFAP antibody positivity became negative following antifungal therapy, indicating transient astrocytic injury. A literature search identified no prior reports describing CSF GFAP antibody positivity in leukemia patients with dual central nervous system (CNS) infections.
Conclusion CM and TBM present with overlapping features and may coexist with autoimmune encephalitis in immunocompromised patients. Incorporating autoimmune antibody testing, including anti-GFAP, into routine CNS infection evaluation can facilitate early recognition of immune-mediated pathology and guide timely antimicrobial-immunomodulatory therapy.
Keywords：cryptococcal meningitiscerebral infarctionGFAP antibodieschronic lymphocytic leukemiatuber-culous meningitis
Publication Date：2025-12-30
Online Publishing Date：2026-01-27(First online date of this platform, not the publication date of the document)
Pages：7( 58-64 )