Cryptococcal meningitis remains a major cause of HIV-related mortality worldwide with majority of cases occurring in sub Saharan Africa. Raised intracranial pressure is a common complication of cryptococcal meningitis and if left untreated is associated with irreversible blindness, deafness and other neurological and neurocognitive impairment. We present two cases which highlight the importance of therapeutic lumbar puncture in the management of raised intracranial pressure in HIV-associated cryptococcal meningitis.

A 40-yr old, heavily-built man initially presented to his general practitioner 2 days before admission with recent onset of pain and swelling in his left calf. A duplex ultrasound scan demonstrated a popliteal and lower leg deep vein thrombosis [DVT], extending 15 cm above the knee into the femoral vein. He was started appropriately on enoxaparin 130 mg bd. Despite the treatment, the pain got worse, particularly when standing, and he was admitted for symptom control.