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[A case of cryptococcal ventriculitis with slowly progressive gait disturbance and memory impairment as initial

Nobuo Yamashiro1, Takamura Nagasaka, Ryusuke Takaki

  • 1Department of Neurology, Faculty of Medicine, University of Yamanashi.

Rinsho Shinkeigaku = Clinical Neurology
|March 10, 2015
PubMed

Insights

Cryptococcal ventriculitis, a rare central nervous system infection, can cause gait disturbance and cognitive impairment. Prompt diagnosis and extensive treatment are crucial for managing this serious fungal infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Cryptococcal infections primarily affect immunocompromised individuals but can occur in the general population.
  • Central nervous system (CNS) involvement, particularly ventriculitis, is a rare but severe complication of cryptococcosis.
  • Progressive gait disturbance and cognitive impairment are potential neurological manifestations.

Observation:

  • A 54-year-old man presented with gait disturbance and cognitive impairment.
  • Brain MRI revealed periventricular white matter hyperintensities and leptomeningeal enhancement.
  • Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis, elevated protein, low glucose, and positive cryptococcal antigen.

Findings:

  • The patient was diagnosed with cryptococcal ventriculitis, a rare manifestation of CNS cryptococcosis.
  • Treatment involved a prolonged course of combination antifungal therapy, including liposomal amphotericin B, fluconazole, voriconazole, and flucytosine.
  • Follow-up MRI showed septum formation, indicating residual ventriculitis despite treatment.

Implications:

  • This case highlights the importance of considering cryptococcal infection in patients with unexplained neurological symptoms and CSF abnormalities.
  • Ventriculitis, though uncommon, is a serious complication of cryptococcosis requiring aggressive and prolonged antifungal management.
  • Early recognition and comprehensive treatment are essential for improving outcomes in CNS cryptococcosis.

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