A Case of Cryptococcus meningoencephalolitis, Gelatinous Type

A report was made on a case of cryptococcus meningoencephalitis, gelatinous type. A 38-year-old woman was in her excellent health untill early May, 1978, when she started complaining of headache and malaise. Several days later, she developed vomiting and high fever. She was admitted to another hospital and treated for suspected tuberculous meningitis. But soon afterward she developed a hemiplegia of left side and anisocoria (R<L), and became somnolent. On June 9 she was brought to the Emergency Center of the Kagoshima City Hospital for the further examination. Neurological examination revealed a hemiplegia of left side, a stiff neck, and anisocoria (R<L). A level of consciousness was semicomatous. Spinal tap yielded clear cerebrospinal fluid with an elevated opening pressure. Ventricular drainage was performed immediately and the ventricular pressure was high. No improvement was noted in any of the symptoms by the ventricular drainage. On RI scan, high uptake was seen in the parietal region (Fig. 1). The culture examination on materials from the spinal tap and ventricular drainage was performed and isolated microorganism was identified as Cryptococcus neoformans. Her condition deteriorated gradually and she died about 2 months after the onset. Postmortem findings were limited to the brain. The brain weighted 1400g. The surface of brain appeared to be covered by a mucin-like material and had a gray-yellow appearance. On the frontal sectioning of the formalin-fixed brain, small cysts measuring up to 5×5mm, were found in the basal ganglia (Fig. 2) and cerebellar dentate ganglia. These cysts consisted of many spherical organisms with gelatinous substance (Cryptococcus neoformans) (Fig. 3). Characteristically the inflammatory response by lymphocytes was minimal (Fig. 3). All of organisms were surrounded by a thick gelatinous capsule. The capsule of the Cryptococcus had strong affinity for mucopolysaccharide stains (Fig. 5). The radiating spike pattern of the capsule could be seen (Fig. 4). No apparent intracellular structures of the fungus were revealed. It was considered from our case that an early treatment for cryptococcosis should be performed in patients in whom the possibility of cryptococcal infection was suspected.