Chronic Ventriculitis Caused by Cryptococcus neoformans: A Rare Presentation

Cryptococcus neoformans is a fungus notorious for invading the central nervous system. while Cryptococcus is known to cause meningitis, encephalitis, and meningoencephalitis in immunocompromised patients, especially those with AIDS (CD4 <100), and found to be rapidly fatal, instances of ventricular involvement with chronic sequelae are exceedingly rare. Typical presentations of cryptococcal meningitis involve headache, altered mental status, nuchal rigidity, and vomiting. We report a case of a 58-year-old HIV-positive male who presented with intermittent headaches and changes in gait. The MRI revealed ventriculomegaly and advanced chronic sequela of prior ventriculitis with serum and CSF cryptococcal antigen being positive. The treatment of cryptococcal chronic ventriculitis requires a multidisciplinary approach involving internal medicine, neurosurgery, neurology, and infectious diseases. However, this patient's CSF had no pleocytosis and had very high protein, which is a poor prognostic indicator for this disease and could have been prevented with the prompt recognition of the condition before it had progressed to the chronic stage. We recommend that clinicians maintain a high index of suspicion for opportunistic infections, such as cryptococcal meningitis, in any patient with HIV regardless of typical clinical findings.