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Two cases of Cryptococcus meningitis presenting as leukoencephalopathy prior to amphotericin therapy

R A Wilcox1, D Thyagarajan, P Kempster

  • 1Department of Neurology, Flinders Medical Center, Adelaide, SA, Australia. robert.wilcox@fmc.sa.gov.au

European Journal of Neurology
|March 16, 2007
PubMed

Insights

Cryptococcal meningitis in immunocompromised patients can present with unusual white matter lesions on MRI, mimicking demyelination. These lesions, potentially an immune response, resolved with treatment.

Area of Science:

  • Neuroscience
  • Immunology
  • Infectious Diseases

Background:

  • Cryptococcal meningitis is a serious fungal infection, particularly in individuals with combined immunodeficiency.
  • Typical imaging findings include cryptococcomas, but atypical presentations are increasingly recognized.

Observation:

  • Two patients with combined immunodeficiency and cryptococcal meningitis exhibited unusual gadolinium-enhancing white matter lesions on MRI.
  • These lesions differed from cryptococcomas and were observed before antifungal therapy.

Findings:

  • Biopsy in one patient revealed *Cryptococcus* organisms and inflammatory changes, but not demyelination, despite the lesions' resemblance to demyelinating plaques.
  • Leukoencephalopathy, previously attributed to amphotericin toxicity, was noted in these cases.

Implications:

  • This presentation suggests leukoencephalopathy may be an immune-mediated response to *Cryptococcus* in the central nervous system.
  • Highlights the need to consider atypical imaging findings in diagnosing and managing cryptococcal meningitis in immunocompromised individuals.

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