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Two cases of Cryptococcus meningitis presenting as leukoencephalopathy prior to amphotericin therapy
Author(s) -
Wilcox R. A.,
Thyagarajan D.,
Kempster P.
Publication year - 2007
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2006.01561.x
Subject(s) - leukoencephalopathy , medicine , amphotericin b , cryptococcus , progressive multifocal leukoencephalopathy , cryptococcus neoformans , meningitis , cryptococcal meningitis , pathology , magnetic resonance imaging , white matter , immunology , dermatology , radiology , human immunodeficiency virus (hiv) , antifungal , pediatrics , multiple sclerosis , microbiology and biotechnology , viral disease , biology
We report two patients with cryptococcal meningitis and combined immunodeficiency with unusual magnetic resonance imaging findings of gadolinium‐enhancing white matter lesions, quite different from cryptococcomas and seen prior to anti‐fungal treatment. The lesions resembled demyelinating plaques and resolved. In one patient, biopsy of the lesion revealed cryptococci, non‐specific inflammatory changes and occasional small perivascular lymphocyte collections, but not demyelination. Leukoencephalopathy, previously rarely observed in Cryptococcal meningitis, was thought to be the sequelae of amphotericin toxicity. Our cases demonstrate cryptococcal meningitis may present with leukoencephalopathy, possibly as an immune response to the organism.