BMJ Case Reports 2018; doi:10.1136/bcr-2017-221435
  • Unusual association of diseases/symptoms

Cryptococcal meningitis in a daily cannabis smoker without evidence of immunodeficiency

  1. Waguih William IsHak2,6
  1. 1Department of Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, California, USA
  2. 2Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
  3. 3F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  4. 4Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  5. 5Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
  6. 6David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  7. 7UCLA Fielding School of Public Health, Los Angeles, California, USA
  1. Correspondence to Bryan B Shapiro MD and MPH, bryan.shapiro{at}
  • Accepted 5 December 2017
  • Published 26 January 2018


Cryptococcal meningitis is a life-threatening condition most commonly observed in immunocompromised individuals. We describe a daily cannabis smoker without evidence of immunodeficiency presenting with confirmed Cryptococcus neoformans meningitis. An investigation of cannabis samples from the patient’s preferred dispensary demonstrated contamination with several varieties of Cryptococcus, including C. neoformans, and other opportunistic fungi. These findings raise concern regarding the safety of dispensary-grade cannabis, even in immunocompetent users.


  • Contributors Study concept and design: WWI, RH, BS, Danovitch I. Acquisition of data: RH, BS, BV. Analysis and interpretation of data: BS, Morgan M, Becker C, Nguyen C, Underhill DM. Drafting of the manuscript: BS, Kopple JD, BV. Critical revision of the manuscript for important intellectual content: BS, Kopple JD. Administrative, technical or material support: WWI, Danovitch I, BS. Study supervision: WWI, Danovitch I.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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