title: Mesencephalic cryptococcal abscesses presenting with parkinsonism as an initial manifestation of AIDS.
abstract: Parkinsonism has been associated with HIV/AIDS and cerebral cryptococcal disease, but to date there has been no report of histological cryptococcal lesions in the substantia nigra (SN) in a patient with parkinsonism. We report on a case of a 63-year-old man who presented with tremor, gait disturbance, and mask-like facies, and showed cryptococcal meningoencephalitis with cryptococcal abscesses in the SN at autopsy, without Lewy bodies or significant degeneration of the SN neurons. Parkinsonism also represented the first manifestation of AIDS in this previously undiagnosed patient. This case highlights the importance of considering infectious etiologies in patients presenting with parkinsonism, and underscores the need for autopsy in evaluation of patients with new or unexplained movement disorders. Movement disorders in association with AIDS and mesencephalic mass lesions are discussed.
authors.affiliation: Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA. Bouffardj@afip.osd.mil
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Bouffard
authors.forename: Hernando
authors.initials: H
authors.lastname: Mena
authors.forename: Mary
authors.initials: M
authors.lastname: Ripple
authors.forename: Juan
authors.initials: J
authors.lastname: Troncoso
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology*; D008636:Mesencephalon / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000209:etiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed