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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(06): 607-609
DOI: 10.1055/s-0043-1768159
Images in Neurology

Hydrocephalus, massive myelitis, and adhesive arachnoiditis: full neuroaxis involvement by neurocryptococcosis

Hidrocefalia, mielite maciça e aracnoidite adesiva: envolvimento de todo o neuroeixo por neurocriptococose
André Eduardo de Almeida Franzoi 
1   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neurologia, Departamento de Clínica Médica, Curitiba PR, Brazil.
,
Tamiris Maier Silva Ferreira 
2   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Infectologia, Departamento de Clínica Médica, Curitiba PR, Brazil.
,
Emanuele Therezinha Schueda Stonoga 
3   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Anatomia Patológica e Histopatologia, Departamento de Clínica Médica, Curitiba PR, Brazil.
,
Bernardo Corrêa de Almeida Teixeira 
4   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Radiologia, Departamento de Clínica Médica, Curitiba PR, Brazil.
,
Rosana Herminia Scola 
5   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Doenças Neuromusculares, Departamento de Clínica Médica, Curitiba PR, Brazil.
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A 37-year-old male patient presented with subacute paraparesis, urinary incontinence, and a sensory level of T8. An analysis of the cerebrospinal fluid revealed lymphocytic pleocytosis (5 white blood cells/mm3), low levels of glucose (25 mg/dL), increased levels of protein (713 mg/dL), high levels of lactic acid (4.7 mmol/L), and positive cryptococcal antigen. A magnetic resonance imaging (MRI) scan showed hydrocephalus ([Figure 1]), myelopathy ([Figure 2]), and adhesive arachnoiditis ([Figure 3]). Meningeal biopsy showed round cells suggestive of cryptococcosis ([Figure 4]), without species differentiation in the culture samples. Cryptococcus may exhibit unique clinical manifestations, such as gelatinous pseudocysts in the basal ganglia, cerebral cryptococcomas, leptomeningitis, cranial neuropathies, adhesive arachnoiditis, and obstructive hydrocephalus.[1] [2] [3] [4] [5]

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Figure 1 (A,B) Axial contrast-enhanced T1-weighted magnetic resonance imaging (MRI) scan revealing leptomeningeal enhancement at the base of the brain in the posterior fossa; (C–F) axial fluid-attenuated inversion recovery (FLAIR) MRI showing hydrocephalus throughout the ventricular system, without significant transudation of the cerebrospinal fluid.
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Figure 2 (A) Sagittal T2-weighted MRI showing septations in the subarachnoid space around the spinal cord; (B) sagittal short-tau inversion recovery (STIR) MRI showing hyperintensity and distortion in the spinal cord; (C) sagittal contrast-enhanced T1-weighted MRI revealing leptomeningeal enhancement around the entire spinal canal.
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Figure 3 (A–D): Axial T2-weighted MRI showing adhesive arachnoiditis and septations distorting the spinal cord at the level of the thoracic spinal cord; (E,F) axial T2-weighted MRI showing adhesive arachnoiditis and septations distorting the spinal cord at the level of the lumbosacral spinal cord.
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Figure 4 Encapsulated, spherical-to-oval yeast cells (5–10 μm in diameter) with narrow-based budding and polysaccharide capsules. The yeast cells vary in size, and the organisms can be capsule-deficient. (A) Grocott methenamine silver (GMS), smallest increase (×20); yeast cells tested positive for GMS; (B) hematoxylin and eosin staining, the smallest increase (×20); (C) periodic acid Schiff–diastase (PAS‒D), highest magnification (×40); yeast cells tested positive for PAS‒D staining; (D) PAS‒D, smallest increase (×20).

Authors' Contributions

All authors contributed to the conception and design of the study. AEAF: performed material preparation, data collection and analysis, and wrote the first draft of the manuscript, and all authors commented on previous versions and read and approved the final manuscript.




Publication History

Received: 22 November 2022

Accepted: 15 February 2023

Article published online:
28 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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