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Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report
Damith S Liyanage1, Lakmini P S Pathberiya, Inuka K Gooneratne
1Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka. damithsl@gmail.com.
Background:
Cryptococcus neoformans is saprophytic encapsulated yeast. Infection is acquired by inhalation of the organism and could be asymptomatic or limited to the lungs, specially in the immunocompetent host. Cryptococcal meningitis is a serious opportunistic infection among post transplant recipients. Cranial nerve palsies and ophthalmoplegia are well known complications of this disease, but bilateral complete ophthalmoplegia is a very rare presentation.
Case Presentation:
A Sri Lankan young male, who is a post kidney transplant recipient, presented with bilateral complete ophthalmoplegia and subsequently was diagnosed to have cryptococcal meningitis based on Indian ink stain and culture of cerebrospinal fluid (CSF). His magnetic resonance imaging (MRI) showed bilateral multiple nodular lesions in both basal ganglia and thalami. Brainstem imaging was normal.
Conclusions:
Cryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. Bilateral thalamic lesions, inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient.
Insights
Cryptococcal meningitis is a rare but serious fungal infection in kidney transplant recipients. This case highlights bilateral complete ophthalmoplegia as a rare complication, emphasizing prompt diagnosis in immunocompromised individuals.
Area of Science:
- Mycology
- Infectious Diseases
- Neuro-ophthalmology
Background:
- Cryptococcus neoformans is an encapsulated yeast causing opportunistic infections.
- Cryptococcal meningitis is a severe complication in transplant recipients.
- Ophthalmoplegia is a known complication, but bilateral complete form is exceptionally rare.
Observation:
- A post-kidney transplant patient presented with bilateral complete ophthalmoplegia.
- Cerebrospinal fluid analysis confirmed cryptococcal meningitis.
- MRI revealed bilateral thalamic and basal ganglia lesions.
Findings:
- The patient was diagnosed with cryptococcal meningitis.
- Bilateral complete ophthalmoplegia was the presenting neurological deficit.
- Thalamic lesions and cranial nerve involvement were implicated.
Implications:
- Cryptococcal meningitis requires high suspicion in immunocompromised patients with neurological deficits.
- Early diagnosis and treatment are crucial for managing this severe fungal infection.
- Understanding rare presentations like bilateral ophthalmoplegia aids in clinical management.
