Coexisting cryptococcal and tuberculous meningitis with glial fibrillary acidic protein antibody positivity in chronic lymphocytic leukemia: expanding the spectrum of infection–immunity interplay

Jinli Feng^1#, Ming Fang^2#, Shuang Wang¹, Jun Zhao¹, Xuling Wang¹, Zhuangzhuang Ren³, Jinming Han^4*, Feng Qiu^1*

¹Senior Department of Neurology, PLA General Hospital, Beijing, China

²Department of Anesthesiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China

³Naval Clinical College, the Fifth Clinical Medical College of Anhui Medical University, Hefei, China 4Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China

#J.F. and M.F. have made equal contriloutions.

*J.H. and F.Q.were co-corresponding authors.

*Correspondence: Jinming Han; Email: hanjinming1202@126.com Feng Qiu; Email: qiufengnet@hotmail.com

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 meningitis, cerebral infarction, GFAP antibodies, chronic lymphocytic leukemia, tuberculous meningitis