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Published on: May 19, 2020

Cerebellar-predominant cryptococcal meningoencephalitis complicated by postinfectious inflammatory response syndrome

Carlos Alvarado-De la Hoz1,2, Silvia A Andrade-Rondón3,2, José Andrés Ordoñez Gutierrez3,2

  • 1Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogotá, Colombia carlosalvarado@javeriana.edu.co.

Practical Neurology
|July 9, 2026
PubMed

Insights

Neurological decline in cryptococcal meningoencephalitis can be due to inflammation, not infection. Steroid treatment (methylprednisolone) effectively managed this postinfectious inflammatory response syndrome (PIIRS) in a patient with HIV-negative cryptococcosis.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Immunology

Background:

  • HIV-negative cryptococcal meningoencephalitis can lead to neurological deterioration even with negative cerebrospinal fluid (CSF) cultures.
  • This deterioration is often linked to a postinfectious inflammatory response syndrome (PIIRS).

Purpose of the Study:

  • To describe a case of neurological deterioration in HIV-negative cryptococcal meningoencephalitis.
  • To highlight the role of PIIRS and the efficacy of immunomodulatory treatment.

Main Methods:

  • A case study of a 37-year-old male patient presenting with neurological symptoms.
  • Diagnostic procedures included brain MRI and CSF analysis.
  • Treatment involved antifungal therapy followed by intravenous methylprednisolone for suspected PIIRS.

Main Results:

  • The patient initially improved with antifungal treatment but later deteriorated, showing signs of intracranial hypertension and inflammation on MRI despite sterile CSF cultures.
  • Prompt administration of intravenous methylprednisolone led to rapid clinical improvement and normalization of CSF parameters.
  • This suggests PIIRS as the cause of paradoxical worsening.

Conclusions:

  • Paradoxical neurological worsening in cryptococcal meningoencephalitis necessitates reassessment beyond active infection.
  • Confirming microbiological control enables targeted immunomodulation, such as methylprednisolone, to resolve inflammatory injury.
  • Early recognition and management of PIIRS are crucial for favorable outcomes in cryptococcal meningoencephalitis.
Keywords:
CEREBELLAR ATAXIAINFECTIOUS DISEASESNEUROIMMUNOLOGY

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