Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Alcoholic cirrhosis can predispose individuals to opportunistic infections and neurological complications.
• Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder affecting the brain.
• Cryptococcal meningitis (CM) is a serious fungal infection of the central nervous system.

Observation:

• A 50-year-old man with alcoholic cirrhosis presented with loss of consciousness and tremors.
• Initial investigations revealed limbic encephalitis with hippocampal damage, positive for anti-NMDA and anti-glutamate receptor antibodies.
• Meningeal irritation symptoms emerged during treatment, leading to the diagnosis of cryptococcal meningitis.

Findings:

• The patient exhibited cerebral infarction with reversible stenosis of cerebral arteries.
• Treatment with antifungals and corticosteroids led to CSF normalization and disappearance of NMDA receptor antibodies.
• This case uniquely demonstrates the coexistence of CM and anti-NMDA receptor encephalitis in an adult.

Implications:

• This case underscores the importance of considering co-infections in complex neurological presentations.
• Early and accurate diagnosis is crucial for managing overlapping conditions like encephalitis and meningitis.
• Understanding such rare co-occurrences can improve diagnostic and therapeutic strategies for neurological disorders.