[Clinical and pathological observations on a case of granulomatous encephalitis (probable criptococcal infection)...

A case of granulomatous encephalitis in a 42 year old woman is reported. During the course of her illness, she showed over a short period of time a left hemiparesis, epileptic seizures and severe impairment of consciousness. Bilateral carotic angiography showed no evidence of an expansive lesion, while brain-scan presented an hyperactive area in the right parasagittal region. The cerebrospinal fluid examination demonstrated an increasing hyperproteinosis and death occurred 45 days after the first symptoms appeared. At post mortem in addition to brain edema, a soft, grey-brown discoloured area, of the size of hazel nut was found in the right limbic convolution. Histologically the abnormal tissue revealed a granulomatous structure formed by thick masses of lymphocytes, plasmacells and epithelioid cells among which vessel neoformation and hemorrhages were noted. Remarkable perivascular infiltrations were seen in the white matter, in the gray matter and in the leptomeninges also far away from the granulomatous focus. Many round yeast-like elements were observed free in the tissue as well as inglobated in large histiocytes. Although morphologically they resembled Cryptococcus neoformans organisms, the specific staining techniques for the mycoses were negative. The authors, after reviewing the various histopathological pictures of cryptococcosis in the nervous system and the modern diagnostic procedures for this mycotic infection during life, discuss the range of so-called primitive granulomatous encephalites.