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Infratentorial Cryptococcus neoformans meningoencephalitis with cerebellar infarction: A rare case report

Zhaobo Shi1, Yong Sun1, Hui Liu1

  • 1Neurology Department, Kaingfeng Central Hospital, Kaifeng, China.

Heliyon
|December 26, 2022
PubMed
Abstract

Insights

This case study highlights a rare instance of cryptococcal meningoencephalitis (CM) in an elderly patient with chronic hepatitis B (HBV). The study emphasizes CM as a potential cause of cerebellar infarction and the importance of monitoring renal function during antifungal treatment.

Area of Science:

  • Neuroinfectious diseases
  • Mycology
  • Hepatology

Background:

  • Cryptococcal meningoencephalitis (CM) is a severe fungal infection of the central nervous system (CNS), often affecting immunocompromised individuals but also impacting immunocompetent hosts.
  • While *Cryptococcus neoformans* (C. neoformans) is the primary cause, viral hepatitis B (HBV) is a rare contributing factor.
  • Infratentorial lesions, particularly cerebellar infarction, are uncommon presentations of CM, with the frontal lobe being the most frequently affected cerebral area.

Observation:

  • An elderly female patient with chronic HBV presented with symptoms including dizziness, altered mental status, low-grade fever, and elevated intracranial pressure.
  • Cerebrospinal fluid analysis confirmed *Cryptococcus* infection, identified as *C. neoformans* via Next-Generation Sequencing (NGS).
  • MRI revealed hydrocephalus and infratentorial lesions, including bilateral cerebellar involvement and meningeal enhancement.

Findings:

  • The patient received intravenous amphotericin B (AMB) for 12 days, experiencing transient oliguria, with renal function recovery upon AMB discontinuation.
  • Post-treatment MRI showed significant reduction in cerebellar lesions and an asymptomatic acute infarction in the left cerebellum.
  • The patient was discharged on fluconazole and remained asymptomatic during a two-month follow-up.

Implications:

  • *C. neoformans* infection should be considered in chronic HBV patients presenting with meningoencephalitis.
  • Cerebellar infarction may be a complication of CM, necessitating repeat MRI during antifungal therapy.
  • Close monitoring of renal function during AMB treatment is crucial, as recovery is possible after drug cessation.
Keywords:
Cerebral infarctionCryptococcus meningoencephalitisCryptococcus neoformansInfratentorial meningitis

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