title: Neurogenic pulmonary edema following Cryptococcal meningoencephalitis associated with HIV infection.
abstract: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system insult. Only a few cases of NPE after Cryptococcal meningitis have been reported. We report a case of NPE following Cryptococcal meningoencephalitis. A 40-year-old man with no medical history was hospitalized for disturbance of consciousness. Blood glucose level was 124 mg/dL. Non-contrast head computed tomography showed no abnormalities. Lumbar puncture revealed a pressure of over 300 mm H2 O and cerebrospinal fluid (CSF) confirmed a white blood cell count of 65/mm(3) . The CSF glucose level was 0 mg/dL. The patient was empirically started on treatment for presumptive bacterial and viral meningitis. Four days after, the patient died in a sudden severe pulmonary edema. Autopsy was performed. We found at autopsy a brain edema with small hemorrhage of the right basal ganglia, severe pulmonary edema and mild cardiomegaly. Histologically, dilated Virchow-Robin spaces, crowded with Cryptococci were observed. In the right basal ganglia, Virchow-Robin spaces were destroyed with hemorrhage and Cryptococci spread to parenchyma of the brain. No inflammatory reaction of the lung was seen. Finally, acute pulmonary edema in this case was diagnosed as NPE following Cryptococcal meningoencephalitis. After autopsy, we found that he was positive for serum antibodies to human immunodeficiency virus.
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.|Cancer Center, Fukuoka, Japan.|Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
authors.forename: Reiichiro
authors.initials: R
authors.lastname: Kondo
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sugita
authors.affiliation: Department of Neurology, Saiseikai Futsukaichi Hospital, Fukuoka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Arakawa
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakashima
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Umeno
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Todoroki
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Takase
authors.affiliation: Cancer Center, Fukuoka, Japan.|Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kage
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yano
mesh_terms: D000328:Adult; D000906:Antibodies; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D017809:Fatal Outcome; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000473:pathology*; D008590:Meningoencephalitis / Q000382:microbiology / Q000473:pathology*; D011654:Pulmonary Edema / Q000382:microbiology / Q000473:pathology*
chemical_list: D000906:Antibodies
keywords: HIV; autopsy; cryptococcus; meningitis; pulmonary edema