{
  "abstract": "Background Cryptococcal meningitis associated with ruxolitinib use in patients with myelofibrosis is rare. Furthermore, concomitant findings of cryptococcal meningitis and anti-NMDAr encephalitis have rarely been documented with the first case of an individual presenting with both documented in 2020. The pathophysiology of both is poorly understood. This case presentation hopes to highlight the subtleties in presentation in a highly functional individual who was eventually diagnosed with both cryptococcal meningitis and anti-NMDAr encephalitis.Methods Signed consent was provided by the patient and next of kin. The lead study investigator had sole access to the patient’s records on Electronic Medical Record (EMR), stored notes on the hospital’s secure drive, before translating a de-identified copy of the notes into a case report.Results A 66-year-old man presents to ED with a one-week history of subjective fevers, sweats and lethargy on a background of myelofibrosis, which under CSF analysis was later diagnosed as cryptococcal meningitis & anti-NMDAR encephalitis. To emphasise, there were no meningo-encephalitic changes on CT or MRI brain. The patient’s kidney function continued deteriorating on the regime of flucytosine and amphotericin B despite continued infectious diseases input virtually. Patient was transferred to a tertiary centre for multidisciplinary input.Conclusion There should be a lower threshold to consider performing a lumbar puncture in immunocompromised patients. Whilst worsening confusion is not specific to anti-NMDAr encephalitis, despite the rarity of the condition, clinicians should consider ordering a broader encephalitic screen on CSF analysis, particularly in immunocompromised patients.",
  "authors": [
    {
      "affiliations": [
        "Latrobe Regional Hospital, Traralgon, VIC, Australia"
      ],
      "name": "Benjamin Neale"
    },
    {
      "affiliations": [
        "Latrobe Regional Hospital, Traralgon, VIC, Australia"
      ],
      "name": "Alexandra Yeoh"
    }
  ],
  "title": "3458 A case of cryptococcal meningitis & anti-nmdar encephalitis in a patient with myelofibrosis in Rural Victoria",
  "uid": "9db49d3a-2ece-5e9c-9cd8-919248dfe9dc"
}