A 39-year-old cisgender man with HIV was hospitalized and diagnosed with cryptococcal meningitis. He received 2 weeks of amphotericin B and flucytosine and a repeat lumbar puncture showed a negative cerebrospinal fluid (CSF) fungal culture. Thus, he transitioned to oral fluconazole and 2 weeks later, he started bictegravir-tenofovir alafenamide-emtricitabine. Three months after starting antiretroviral therapy, his CD4 count increased from 20 cells/mm³ to 160 cells/mm³, but his headache and neck stiffness returned. A repeat lumbar puncture showed elevated opening pressure and negative CSF fungal cultures.