Venous Plexus of Batson and Its Important Role in the Development of Cryptococcal Meningitis

Cryptococcosis is an infectious disease caused by Cryptococcus neoformans and is most often found in the lungs, followed by the meninges. However, little is known about the mechanism by which cryptococcal meningitis develops without pulmonary cryptococcosis. A 78-year-old woman visited our hospital due to decreased appetite, difficulty moving, and fever. She had right-sided hemiparesis due to an old cerebral infarction, headache, no nuchal rigidity, a National Institutes of Health Stroke Scale of 4, and no pulmonary disorders on computed tomography. On the fourth day after hospitalization for symptom palliation, venous blood culture revealed C. neoformans infection. Given the high suspicion of cryptococcal meningitis, a lumbar puncture was performed and confirmed the presence of C. neoformans in the cerebrospinal fluid. The patient, therefore, began to receive amphotericin B (3.75 mg/kg) and 5-fluorocytosine (25 mg/kg) four times daily, leading to slow but definite improvement of the cryptococcal meningitis. Based on the clinical symptoms and outcomes of this case, we hypothesize that Batson's venous plexus may be involved in the development of cryptococcal meningitis without pulmonary cryptococcosis. Emergency physicians should note that meningitis resulting from this mechanism often does not present with typical meningitis symptoms.