Cryptococcal and EBV Meningitis in a Postpartum Woman With HIV Despite ART: A Case Challenging the Limits of Immune Reconstitution

Cryptococcal meningitis (CM) is a life-threatening opportunistic infection, mainly affecting immunocompromised patients, especially with advanced HIV/AIDS. Unmasking cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) is a severe but relatively rare complication in the United States. Co-infection with other central nervous system (CNS) pathogens further complicates both diagnosis and management. In this case report, we present a rare instance of CM secondary to C-IRIS alongside EBV meningitis in a postpartum, HIV-positive patient on ART. This co-infection highlights the vulnerability of immunocompromised individuals, even on ART, to multifactorial CNS infections. It emphasizes the need for vigilant monitoring, timely intervention, and comprehensive long-term management in high-risk groups such as postpartum patients, while also highlighting the importance of thorough opportunistic infection screening before ART initiation to reduce the risk of IRIS-related complications.