Case report. Simultaneous fungal and viral infection of the central nervous system

A patient with lymphoma developed central nervous system dysfunction and the diagnosis of cryptococcal meningitis was made. Because of discordant clinical and laboratory responses to appropriate treatment, further investigations were performed and the additional diagnosis of progressive multifocal leukoencephalopathy (PML) was established. Computerized axial tomography (CT scanning) proved helpful in pointing toward the latter disorder. Clinical, neuropathological, and microbiologic features are presented. The diagnostic approach to central nervous system illness in patients with impaired immunocompetence should include consideration of simultaneous infection with multiple agents.