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BACKGROUND: Cryptococcosis is the most common cause of fungal meningitis worldwide and has a mortality of about 181,000 cases annually. It affects mainly HIV-positive patients or people with some cellular immune-response compromise. Even though it is an uncommon disease in immunocompetent subjects it may occur in apparently healthy hosts, in whom it must be recognized because the subacute presentation and the late diagnosis can increase morbidity and mortality on this group. CLINICAL CASE: A 67-year-old male patient, apparently immunocompetent, who consulted referring headache, fever and mental status altered. He was diagnosed with meningeal cryptococcosis by microbiological analyses and serum antigens, treated with fluconazole and liposomal amphotericin B and he had an adequate clinical response with no further complications (after finished the treatment) or neurological sequels. CONCLUSIONS: The clinical suspicion of this entity is very important because multiples causes of immunosuppression result in a major predisposition to the disease. [ABSTRACT FROM AUTHOR]