Occult cryptococcal meningitis presenting as myelopathy from an arachnoid cyst

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Immunocompromised patients are susceptible to opportunistic infections.
• Spinal arachnoid cysts can cause compressive myelopathy.
• Cryptococcosis can present with diverse neurological manifestations.

Purpose of the Study:

• To report a case of cryptococcosis presenting as a thoracic arachnoid cyst.
• To emphasize the importance of considering infections in immunocompromised patients with new-onset cysts.
• To highlight diagnostic challenges and management strategies.

Main Methods:

• Case report of an immunocompromised patient with back pain and neurological deficits.
• Diagnostic imaging (MRI) revealing a thoracic cyst.
• Surgical intervention (laminoplasty, cyst fenestration/resection) with pathological analysis.
• Cerebrospinal fluid analysis (lumbar puncture) for diagnosis.

Main Results:

• Pathological examination of the cyst wall revealed yeast consistent with Cryptococcus.
• Subsequent lumbar puncture confirmed cryptococcal meningitis.
• The patient experienced neurological improvement after surgical decompression and antifungal treatment.
• Cognitive impairment and delirium were noted postoperatively.

Conclusions:

• Subacute, low-grade infections like cryptococcosis should be considered in the differential diagnosis of de novo arachnoid cysts in immunocompromised individuals.
• Prompt diagnosis and multidisciplinary management are essential for favorable outcomes.
• This case underscores the atypical presentations of opportunistic infections in immunocompromised hosts.