Cryptococcal ventriculitis

Case contributed by Dr Sathiyaseelan Maniharan

Presentation

A known diabetic patient presented with sudden onset of fever and headache.

Patient Data

Age: 56 years
Gender: Male
Modality: MRI

There is subependymal periventricular hyperintensity along the lateral and third ventricles in the T2 (not shown) and FLAIR sequences. The ventricular walls show diffusion restriction. The choroid plexus and ventricular walls show contrast enhancement. There is no basal meningeal contrast enhancement. The rest of the brain MRI is normal.
The MRI features are consistent with ventriculitis.

Case Discussion

This particular patient's CSF analysis revealed raised cryptococcal antigen and positive India ink staining. Blood culture was positive for Cryptococcus neoformans. HIV screening was negative. He was managed  with intravenous amphotericin. The clinical and radiological features are consistent with cryptococcal ventriculitis.

Cryptococcus neoformans is an encapsulted yeast that mainly affects the central nervous system. CNS cryptococcosis is common in HIV-AIDS patients, much less so in immunocompromised patients due to other etiologies (e.g. diabetes). CNS cryptococcosis may manifest as meningitis, encephalitis, meningoencephalitis, and ventriculitis.

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Case Information

rID: 52316
Case created: 2nd Apr 2017
Last edited: 7th Apr 2017
Inclusion in quiz mode: Excluded

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