Meningoradiculitis due to Cryptococcus neofermans in an immunocompetent patient

Abstract

-Meningoradiculitis refers to combined involvement of meninges and nerve roots. The most frequent location is the lumbosacral region. Etiology is diverse, including inflammatory, infectious and neoplastic disorders. Meningoradiculitis is a rare form of involvement in cryptococcal infection. We describe a case of subacute lower limbs flaccid paresis diagnosed as lumbosacral meningoradiculitis in view of cerebrospinal fluid (CSF) inflammatory changes and typical enhancement on MRI of lumbar spine. Cryptococcus neoformans was isolated from CSF. Extensive screening yielded no immunodeficiencies.KEY WORDS: Cryptococcus neoformans, meningoradiculitis, immunocompetent. Meningorradiculite lombossacra causada por Cryptococcus neoformans em paciente imunocompetenteRESUMO -Meningorradiculite refere-se ao envolvimento simultâneo das meninges e das raízes dos nervos. O local mais freqüentemente acometido é a região lombossacra. Patologias inflamatórias, infecciosas e neoplásicas são as causas mais freqüentes. Meningorradiculite é manifestação rara de infecção por Cryptococcus neoformans. Descrevemos um caso de paresia flácida dos membros inferiores, com diagnóstico de meningorradiculite lombossacra baseado nos achados clínicos, de ressonância magnética da coluna lombar e em alterações inflamatórias do líquido cefalorraqueano (LCR). Avaliação microbiológica do LCR revelou a presença de Cryptococcus neoformans e extensa investigação clínica e laboratorial excluiu imunodeficiências primárias e adquiridas. PALAVRAS-CHAVE:Cryptococcus neoformans, meningorradiculite, imunocompetente.Meningoradiculitis refers to combined and exclusive involvement of meninges and nerve roots. The most frequent location is the lumbosacral region. Etiology is diverse, including inflammatory, infectious and neoplastic disorders. Our aim is to describe and discuss a case of lumbosacral meningoradiculitis caused by Cryptococcus neoformans in an immunocompetent patient.

Myeloradiculitis caused by Cryptococcus neoformans infection in a patient with ulcerative colitis: A neuropathological study

“…To our knowledge, there are five reports of seven cases with cryptococcal myelitis/radiculitis in the literature [5][6][7][8][9], none of whom were studied by necropsy. Of these, four cases showed myeloradiculitis [7,9], while three had meningoradiculitis [5,6,8]. HIV infection was noted in three cases [7,9], whereas another four cases were reported to be immunocompetent [5,6,8,9].…”

“…Of these, four cases showed myeloradiculitis [7,9], while three had meningoradiculitis [5,6,8]. HIV infection was noted in three cases [7,9], whereas another four cases were reported to be immunocompetent [5,6,8,9]. Antifungal therapy was ineffective in two HIV-infected patients, culminating in death [7,9], while it was successful in another five patients, resulting in complete or partial resolution of neurologic impairment [5,6,8,9].…”

“…HIV infection was noted in three cases [7,9], whereas another four cases were reported to be immunocompetent [5,6,8,9]. Antifungal therapy was ineffective in two HIV-infected patients, culminating in death [7,9], while it was successful in another five patients, resulting in complete or partial resolution of neurologic impairment [5,6,8,9]. C. neoformans was isolated from five patients [6,8,9] and Cryptococcus curvatus from one [7], and in the remaining cases, only yeast cells and cryptococcal antigen were detected in CSF [5] .Among four immunocompetent hosts, two were infected with C. neoformans var.…”

“…It usually manifests with headache, nausea and neck stiffness, finally leading to consciousness disturbance or coma. There are only a few reports describing cryptococcal myelitis and/or radiculitis [5][6][7][8][9]. Furthermore, there are no reports describing the neuropathological findings of cryptococcosis involving nerve roots.…”

Cryptococcus neoformans Peritonitis in a Patient with Alcoholic Cirrhosis: Case Report and Review of the Literature

“…Although cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals, it is also observed in patients without obvious signs of immune deficiency [13][14][15][16]. Typical clinical manifestations are meningoencephalitis and pulmonary infiltrates, whereas the involvement of other organ systems is less common.…”