CNS cryptococcosis presenting with cerebellar stroke and spinal arachnoiditis

Area of Science:

• Neuroscience
• Infectious Diseases
• Immunology

Background:

• Central nervous system (CNS) infections are a significant concern in individuals with advanced Human Immunodeficiency Virus (HIV) infection.
• Cryptococcosis, caused by the fungus Cryptococcus neoformans, can present with diverse neurological manifestations.

Observation:

• A 67-year-old, treatment-naive AIDS patient presented with prolonged fever, limb weakness, and altered sensorium.
• Cerebellar lesions with diffusion restriction and severe spinal arachnoiditis were observed on MRI.
• Initial suspicion of CNS tuberculosis led to delayed diagnosis despite antitubercular therapy.

Findings:

• Positive serum cryptococcal antigen and subsequent cerebrospinal fluid analysis confirmed cryptococcosis.
• The patient experienced a rare presentation of cryptococcal cerebellar stroke and spinal arachnoiditis.
• Diagnostic challenges were encountered due to repeated dry taps during lumbar puncture.

Implications:

• This case underscores the importance of considering opportunistic infections like cryptococcosis in the differential diagnosis of neurological symptoms in AIDS patients.
• Rare presentations, such as cryptococcal cerebellar stroke, can mimic other CNS pathologies, necessitating a high index of suspicion.
• Early and accurate diagnosis of CNS cryptococcosis is crucial for timely initiation of antifungal therapy and improved patient outcomes.