Cryptococcal meningitis

Case contributed by Dr Eric F Greif

Presentation

Double vision, fevers, and headaches

Patient Data

Age: 58
Gender: Male
Modality: MRI

There is marked diffuse leptomeningeal enhancement most pronounced over the cerebellum and in the basal cisterns. There is also nodular enhancement in the right basal ganglia likely via the perivascular spaces.

There is a focus of restricted diffusion in the left inferomedial cerebellum compatible with a small PICA branch infarction. There is no hemorrhage. 

Small polyps or retention cysts in the maxillary sinuses.

 

Case Discussion

Etiologies of leptomeningeal enhancement include: infection (viral, bacterial, or fungal), sarcoid, or neoplastic (lymphoma or carcinomatous).

In this case patient had a spinal tap and CSF demonstrated: (reference range)

  • Color/appearance: Colorless, clear
  • WBC: High 89 (0-10/UL)
  • RBC: 12
  • Neutrophils: High 11% (0-6%)
  • Lymphocytes: High 86% (40-80%)
  • Monocytes: Low 3% (15-45%)
  • Glucose: 49 (40-70 MG/DL)
  • Total Protein: High 118 (15-45 MG/DL)
  • Gram Smear: No Cells Seen
  • VDRL: nonreactive
  • Indian Ink and Culture: Positive for C. neoformans.

The patient was diagnosed with Cryptococcal meningitis. There was no known history of HIV. The patient was also found to have a small left PICA infarct likely secondary to vacuities/spasm.  

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Case Information

rID: 35505
Case created: 8th Apr 2015
Last edited: 31st May 2016
Inclusion in quiz mode: Included

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