CNS cryptococcosis presenting with cerebellar stroke and spinal arachnoiditis.

Megha Priyadarshi, Praveen Tirlangi, Harshit Kadnur, Ranveer Jadon

BMJ case reports 2022 Feb 07

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A 67-year-old man presented with a low-grade fever for 2 months, weakness of all four limbs for five days and altered sensorium for two days. He was recently diagnosed with AIDS and was treatment-naive. Investigations revealed a CD4 count of 27cells/mm3 MRI brain and spine exhibited bilateral cerebellar lesions with diffusion restriction, and severe arachnoiditis at the level of the lumbar spine. High suspicion of central nervous system tuberculosis in an endemic country like ours, led us to start antitubercular therapy and steroids. Repeated lumbar punctures resulted in a dry tap leading to a delay in diagnosis. Serum cryptococcal antigen detection came positive, following which antifungal treatment was initiated. Later a small amount of cerebrospinal fluid sample was obtained which confirmed the diagnosis of cryptococcosis. However, the patient worsened and succumbed to the illness. This case highlighted the rare presentation of cryptococcal cerebellar stroke and spinal arachnoiditis. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Megha Priyadarshi, Praveen Tirlangi, Harshit Kadnur, Ranveer Jadon. CNS cryptococcosis presenting with cerebellar stroke and spinal arachnoiditis. BMJ case reports. 2022 Feb 07;15(2)