Cryptococcal meningoencephalitis

Case contributed by Dr Italo Cavallo Bermudes

Presentation

HIV positive. Headache.

Patient Data

Age: 55 years
Gender: Male
CT

Presentation CT

Normal examination. 

CT

Five days later CT

Appearance of poorly defined subcortical and basal ganglia hypodense lesions, without significant mass effect

The examination shows multiple T2/FLAIR hyperintense cortical-subcortical lesions in the basal ganglia and supra- and infra-tentorial white matter bilaterally. Mostly, they have diffusion restriction to with discrete linear contrast enhancement, and without significant mass effect. It is accompanied by diffuse pachymeningeal thickening and enhancement.

Case Discussion

Opportunistic infections are a frequent diagnosis in immunosuppressed patients. Cryptococcus spreads through the perivascular spaces to the basal ganglia, thalamus, and periventricular white matter. Characteristically they results in an increase in the size of the perivascular spaces that contain gelatinous content.

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Case information

rID: 58655
Published: 3rd Mar 2018
Last edited: 4th Mar 2018
Inclusion in quiz mode: Included
Institution: Hospital San Juan de Dios

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