Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

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  • Sakiyama Yusuke
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Matsuura Eiji
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Shigehisa Ayano
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Hamada Yuki
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Dozono Mika
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Nozuma Satoshi
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Nakamura Tomonori
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Higashi Keiko
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Hashiguchi Akihiro
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
  • Takahashi Yukitoshi
    Department of Pediatrics, National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
  • Takashima Hiroshi
    Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan

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Abstract

<p>We herein report a 50-year-old man with alcoholic cirrhosis who developed loss of consciousness and tremor of the upper limbs. Magnetic resonance imaging findings were suggestive of limbic encephalitis with bilateral hippocampal damage, and a cerebrospinal fluid (CSF) examination confirmed anti-N-methyl-D-aspartate (NMDA) and anti-glutamate receptor antibodies. Despite initial corticosteroid therapy, meningeal irritation symptoms appeared, owing to the development of cryptococcal meningitis (CM), diagnosed by the detection of cryptococcal capsular polysaccharide antigen in the follow-up CSF analysis. Cerebral infarction with reversible stenosis of major cerebral arteries during the clinical course was also observed. Following administration of antifungals and corticosteroids, the number of cells in the CSF gradually declined, and NMDA receptor antibodies disappeared. Our study demonstrates the unique coexistence of CM with anti-NMDA receptor encephalitis in adults. </p>

Journal

  • Internal Medicine

    Internal Medicine 59 (18), 2301-2306, 2020-09-15

    The Japanese Society of Internal Medicine

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