title: Unusual presentations of nervous system infection by Cryptococcus neoformans.
abstract: Nervous system infections by Cryptococcus neoformans may occur not only in congenital or acquired immunodeficiency syndromes, but also in immunocompetent hosts. Neurological manifestations of C. neoformans infection include meningitis and, less commonly, parenchymal CNS granulomatous disease. This paper provides detailed clinical descriptions of highly unusual neurological manifestations of cryptococcal nervous system infections. Medical records and diagnostic data including magnetic resonance imaging, histopathology, serology, and CSF analysis were reviewed. A conus medullaris abscess was found in a patient infected with the human immunodeficiency virus (HIV). A patient with Hodgkin's disease was diagnosed with cryptococcal meningitis and dermatitis mimicking ophthalmic zoster. An immunocompetent patient presented with recurrent cerebral infarctions in the setting of cryptococcal meningitis. Cryptococcal infections of the nervous system can cause severe neurological disability when diagnosis is delayed. Sensitive and specific tests are readily available and should be considered when an unusual clinical presentation is encountered.
authors.affiliation: Department of Neurology, Harvard University School of Medicine, Boston, MA 02215, United States. dsearls@bidmc.harvard.edu
authors.forename: D
authors.initials: D
authors.lastname: Eric Searls
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Sico
authors.forename: S
authors.initials: S
authors.lastname: Bulent Omay
authors.forename: Serguei
authors.initials: S
authors.lastname: Bannykh
authors.forename: Victoria
authors.initials: V
authors.lastname: Kuohung
authors.forename: Joachim
authors.initials: J
authors.lastname: Baehring
mesh_terms: D000038:Abscess / Q000150:complications / Q000382:microbiology / Q000473:pathology; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001921:Brain / Q000382:microbiology / Q000473:pathology; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003455:Cryptococcus neoformans; D015658:HIV Infections / Q000150:complications; D006689:Hodgkin Disease / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000935:Antifungal Agents; D014859:Warfarin; D000666:Amphotericin B