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Unusual pattern of enhancement in cryptococcal meningitis: in vivo findings with postmortem correlation
L Arnder1, M Castillo, E R Heinz
1Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, USA.
Abstract:
Leptomeningeal enhancement on CT and MR imaging studies secondary to cryptococcal meningitis is an uncommon finding. In immunocompromised patients, this meningitis incites only a mild inflammatory reaction and abnormalities are often absent on imaging studies. We recently encountered two patients with cryptococcal meningitis in whom postcontrast MR imaging showed thick enhancing subarachnoid spaces. Both had cryptococcal meningitis at autopsy. In a different patient with cryptococcal meningitis, postmortem MR imaging and pathologic examinations showed that these areas of enhancement correspond to abundant mucoid material secreted by the yeasts.
Insights
Leptomeningeal enhancement on imaging for cryptococcal meningitis is rare, especially in immunocompromised patients. Postcontrast MRI revealed thick enhancing subarachnoid spaces, linked to mucoid material secreted by yeasts.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cryptococcal meningitis is a serious fungal infection, particularly in immunocompromised individuals.
- Imaging findings in cryptococcal meningitis, such as leptomeningeal enhancement, are often subtle or absent due to a mild inflammatory response.
Observation:
- Two patients with cryptococcal meningitis presented with thick enhancing subarachnoid spaces on postcontrast MRI.
- Autopsy confirmed cryptococcal meningitis in both cases.
- Postmortem examination in another patient revealed that the enhancement correlated with abundant mucoid material secreted by Cryptococcus yeasts.
Findings:
- Leptomeningeal enhancement on CT and MR imaging is an uncommon sign of cryptococcal meningitis.
- The observed enhancement in the subarachnoid spaces is associated with mucoid material produced by Cryptococcus neoformans.
Implications:
- Recognizing this imaging pattern can aid in the diagnosis of cryptococcal meningitis, even when typical inflammatory signs are absent.
- This finding highlights the importance of considering fungal infections in the differential diagnosis of unexplained leptomeningeal enhancement.
- Further research may explore the diagnostic utility of identifying mucoid material in imaging studies for cryptococcal meningitis.
