Cryptococcal meningitis (CM) can coexist with malignancy in patients not infected by human immunodeficiency virus (HIV). The purpose of this study was to evaluate the clinical characteristics and therapeutic outcomes of non-HIV-infected patients with CM with malignancy.

The study cohort comprised 320 patients diagnosed with CM from January 2013 to May 2019. Malignancy was diagnosed based on the medical history, imaging findings, and pathological findings. One-hundred-and-four patients also underwent positron emission computed tomography (PET-CT) examination to enable the early detection of possible malignancies. The demographics, clinical characteristics, and outcomes were analyzed.

Twelve patients with CM with malignancies were found. Seven were patients with CM who had a history of malignancies (CM in malignancy; CIM), while five patients had malignancies detected after being diagnosed with CM (malignancy in CM; MIC). The patients with CM with malignancies, especially MIC, were older than those without malignancies. The outcome was similar for patients with CIM and patients with CM without malignancy, but was extremely poor for patients with MIC. PET-CT examination suggested malignancy in five of 104 patients, with malignancy finally confirmed in four of five patients.

Compared with the general population, the rate of solid malignancies was increased in patients with CM, especially older adults. The presence of malignancies and timing of discovery were closely related to the outcome of patients with CM. Thus, it is necessary to screen for malignancies in older adults with CM. PET-CT might be useful for early malignancy screening of patients with CM.