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Mesencephalic cryptococcal abscesses presenting with parkinsonism as an initial manifestation of AIDS

John-Paul Bouffard1, Hernando Mena, Mary Ripple

  • 1Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA. Bouffardj@afip.osd.mil

Movement Disorders : Official Journal of the Movement Disorder Society
|November 26, 2003
PubMed

Insights

Parkinsonism can be caused by infections like cryptococcal meningoencephalitis, particularly in undiagnosed AIDS patients. Autopsies revealed cryptococcal abscesses in the substantia nigra, explaining parkinsonism without Lewy bodies.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pathology

Background:

  • Parkinsonism is often associated with HIV/AIDS and cryptococcal disease.
  • Histological evidence of cryptococcal lesions in the substantia nigra (SN) linked to parkinsonism has not been previously reported.

Observation:

  • A 63-year-old male presented with classic parkinsonism symptoms: tremor, gait disturbance, and mask-like facies.
  • The patient was diagnosed with cryptococcal meningoencephalitis, with autopsy revealing cryptococcal abscesses in the SN.
  • No Lewy bodies or significant neuronal degeneration were observed in the SN.

Findings:

  • This case demonstrates cryptococcal abscesses in the substantia nigra causing parkinsonism in an undiagnosed patient with Acquired Immunodeficiency Syndrome (AIDS).
  • Parkinsonism was the initial clinical manifestation of AIDS in this patient.

Implications:

  • Highlights the importance of considering infectious etiologies, such as cryptococcosis, in the differential diagnosis of parkinsonism.
  • Underscores the critical role of autopsy in evaluating unexplained movement disorders, especially in immunocompromised individuals.
  • Suggests a potential mechanism for movement disorders in AIDS patients involving mesencephalic lesions.

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