[A case of cryptococcal ventriculitis with slowly progressive gait disturbance and memory impairment as initial symptoms].
A 54-year-old man was admitted due to progressive gait disturbance and cognitive impairment. On MRI, a hyperintense region was observed in the periventricular white matter on FLAIR imaging, with Gd-enhancement in the choroid plexus and periventricular wall. Cerebrospinal fluid (CSF) examination showed marked abnormalities including a high white blood cell count (WBC, 360 cells/mm(3). 83% lymphocytes), an elevated protein level (1,416 mg/dl), a low glucose level (12 mg/dl), and elevated cryptococcal antigen with positive Indian ink staining. Cryptococcal ventriculitis was diagnosed. The patient was initially treated with liposomal amphotericin B, fluconazole, voriconazole, and flucytosine for 38 weeks, followed by administration of itraconazole and fluconazole with some improvement. The brain MRI after one month showed septum formation in the posterior horn, which was suggestive of ventriculitis. Although ventriculitis is rare, we should pay attention to the presence of ventriculitis due to cryptococcal infection in the central nervous system.
Department of Neurology, Faculty of Medicine, University of Yamanashi.
Nobuo
N
Yamashiro
Takamura
T
Nagasaka
Ryusuke
R
Takaki
Michiaki
M
Miwa
Kazumasa
K
Shindo
Yoshihisa
Y
Takiyama
D000935:Antifungal Agents / Q000008:administration & dosage; D000946:Antigens, Fungal / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000134:cerebrospinal fluid; D058565:Cerebral Ventriculitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D003453:Cryptococcosis; D003455:Cryptococcus neoformans / Q000276:immunology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology*; D008875:Middle Aged
D000935:Antifungal Agents; D000946:Antigens, Fungal; D015415:Biomarkers