Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis
Abstract Cryptococcal meningoencephalitis can occur in both previously healthy and immunocompromised hosts. Here, we describe a 55 year-old HIV-negative male with no known prior medical problems, who presented with three months of worsening headaches, confusion, and memory changes without fever. Mag...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-06-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-08349-y |
| _version_ | 1827923139116400640 |
|---|---|
| author | Mohammad El-Atoum Jessica C. Hargarten Yoon-Dong Park Kenneth Ssebambulidde Li Ding Prashant Chittiboina Dima A. Hammoud Seher H. Anjum Seth R. Glassman Shehzad Merchant Peter R. Williamson John C. Hu |
| author_facet | Mohammad El-Atoum Jessica C. Hargarten Yoon-Dong Park Kenneth Ssebambulidde Li Ding Prashant Chittiboina Dima A. Hammoud Seher H. Anjum Seth R. Glassman Shehzad Merchant Peter R. Williamson John C. Hu |
| author_sort | Mohammad El-Atoum |
| collection | DOAJ |
| description | Abstract Cryptococcal meningoencephalitis can occur in both previously healthy and immunocompromised hosts. Here, we describe a 55 year-old HIV-negative male with no known prior medical problems, who presented with three months of worsening headaches, confusion, and memory changes without fever. Magnetic resonance imaging of the brain demonstrated bilateral enlargement/enhancement of the choroid plexi, with hydrocephalus, temporal and occipital horn entrapments, as well as marked periventricular transependymal cerebrospinal fluid (CSF) seepage. CSF analysis yielded a lymphocytic pleocytosis and cryptococcal antigen titer of 1:160 but sterile fungal cultures. Despite standard antifungal therapy and CSF drainage, the patient had worsening confusion and persistently elevated intracranial pressures. External ventricular drainage led to improved mental status but only with valve settings at negative values. Ventriculoperitoneal shunt placement could thus not be considered due to a requirement for drainage into the positive pressure venous system. Due to this persistent CSF inflammation and cerebral circulation obstruction, the patient required transfer to the National Institute of Health. He was treated for cryptococcal post-infectious inflammatory response syndrome with pulse-taper corticosteroid therapy, with resultant reductions in CSF pressures along with decreased protein and obstructive material, allowing successful shunt placement. After tapering of corticosteroids, the patient recovered without sequelae. This case highlights (1) the necessity to consider cryptococcal meningitis as a rare cause of neurological deterioration in the absence of fever even in apparently immunocompetent individuals and (2) the potential for obstructive phenomena from inflammatory sequelae and the prompt response to corticosteroid therapy. |
| first_indexed | 2024-03-13T04:52:16Z |
| format | Article |
| id | doaj.art-48085bc7ea7b4dc0843e57c608cb60d4 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-13T04:52:16Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-48085bc7ea7b4dc0843e57c608cb60d42023-06-18T11:07:56ZengBMCBMC Infectious Diseases1471-23342023-06-012311810.1186/s12879-023-08349-yPersistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitisMohammad El-Atoum0Jessica C. Hargarten1Yoon-Dong Park2Kenneth Ssebambulidde3Li Ding4Prashant Chittiboina5Dima A. Hammoud6Seher H. Anjum7Seth R. Glassman8Shehzad Merchant9Peter R. Williamson10John C. Hu11Department of Medicine, Good Samaritan Hospital, SSM Health Medical GroupLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHSurgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of HealthCenter for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of HealthLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHDepartment of Medicine, Division of Infectious Diseases, University at BuffaloDepartment of Medicine, Division of Infectious Diseases, University at BuffaloLaboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIHDepartment of Medicine, Division of Infectious Diseases, University at BuffaloAbstract Cryptococcal meningoencephalitis can occur in both previously healthy and immunocompromised hosts. Here, we describe a 55 year-old HIV-negative male with no known prior medical problems, who presented with three months of worsening headaches, confusion, and memory changes without fever. Magnetic resonance imaging of the brain demonstrated bilateral enlargement/enhancement of the choroid plexi, with hydrocephalus, temporal and occipital horn entrapments, as well as marked periventricular transependymal cerebrospinal fluid (CSF) seepage. CSF analysis yielded a lymphocytic pleocytosis and cryptococcal antigen titer of 1:160 but sterile fungal cultures. Despite standard antifungal therapy and CSF drainage, the patient had worsening confusion and persistently elevated intracranial pressures. External ventricular drainage led to improved mental status but only with valve settings at negative values. Ventriculoperitoneal shunt placement could thus not be considered due to a requirement for drainage into the positive pressure venous system. Due to this persistent CSF inflammation and cerebral circulation obstruction, the patient required transfer to the National Institute of Health. He was treated for cryptococcal post-infectious inflammatory response syndrome with pulse-taper corticosteroid therapy, with resultant reductions in CSF pressures along with decreased protein and obstructive material, allowing successful shunt placement. After tapering of corticosteroids, the patient recovered without sequelae. This case highlights (1) the necessity to consider cryptococcal meningitis as a rare cause of neurological deterioration in the absence of fever even in apparently immunocompetent individuals and (2) the potential for obstructive phenomena from inflammatory sequelae and the prompt response to corticosteroid therapy.https://doi.org/10.1186/s12879-023-08349-yCryptococcusIntracranial hypertensionNeuro-inflammationCorticosteroidsPost infectious inflammatory response syndrome |
| spellingShingle | Mohammad El-Atoum Jessica C. Hargarten Yoon-Dong Park Kenneth Ssebambulidde Li Ding Prashant Chittiboina Dima A. Hammoud Seher H. Anjum Seth R. Glassman Shehzad Merchant Peter R. Williamson John C. Hu Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis BMC Infectious Diseases Cryptococcus Intracranial hypertension Neuro-inflammation Corticosteroids Post infectious inflammatory response syndrome |
| title | Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| title_full | Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| title_fullStr | Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| title_full_unstemmed | Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| title_short | Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| title_sort | persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis |
| topic | Cryptococcus Intracranial hypertension Neuro-inflammation Corticosteroids Post infectious inflammatory response syndrome |
| url | https://doi.org/10.1186/s12879-023-08349-y |
| work_keys_str_mv | AT mohammadelatoum persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT jessicachargarten persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT yoondongpark persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT kennethssebambulidde persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT liding persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT prashantchittiboina persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT dimaahammoud persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT seherhanjum persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT sethrglassman persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT shehzadmerchant persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT peterrwilliamson persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis AT johnchu persistentneurologicalsymptomsandelevatedintracranialpressuresinapreviouslyhealthyhostwithcryptococcalmeningitis |