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Cryptococcal meningoencephalitis presenting as cerebral venous thrombosis
Jon Equiza1, Gorka Fernandez-Eulate2, Jon Rodriguez-Antigüedad2
1Neurology Department, University Hospital Donostia, San Sebastian, Spain. jon.equizabazan@osakidetza.eus.
Journal of Neurovirology
|December 22, 2019
Summary
Cryptococcal meningoencephalitis (CM) rarely causes cerebral venous thrombosis (CVT), leading to increased intracranial pressure. This case highlights the critical need for early CM diagnosis in CVT patients to improve outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cerebral venous thrombosis (CVT) presents with diverse neurological symptoms and diagnostic challenges.
- Increased intracranial pressure is a common manifestation in subacute CVT cases.
- Central nervous system (CNS) infections are an uncommon cause of CVT, accounting for only 2% in recent studies.
Observation:
- A 45-year-old patient with no prior medical history presented with symptoms of increased intracranial pressure.
- The patient was diagnosed with cryptococcal meningoencephalitis (CM) complicated by CVT, with initial misdiagnosis of CVT alone.
- Despite treatment including anticoagulation, antifungal therapy, and therapeutic lumbar puncture, the patient's condition deteriorated, leading to respiratory arrest and brain death.
Findings:
- Cryptococcus is a rare cause of CNS infections in developed nations but a leading cause of meningitis in HIV-prevalent regions.
- CVT is an exceptionally rare complication of CM, significantly exacerbating increased intracranial pressure.
- The combination of CM and CVT critically worsened the patient's prognosis.
Implications:
- High clinical suspicion for CM is crucial when diagnosing CVT, especially in endemic areas or immunocompromised individuals.
- Aggressive management of increased intracranial pressure is vital in cases of CM-complicated CVT.
- This case underscores the importance of considering infectious etiologies in CVT and the severe consequences of delayed diagnosis and management.
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