Cryptococcal choroid plexitis: rare imaging findings of central nervous system cryptococcal infection in an immunocompetent individual

Abstract

Central nervous system (CNS) cryptococcosis is a common opportunistic fungal infection in immunocompromised patients, and the imaging findings differ from those in immunocompetent patients. Here, we present the imaging findings in an immunocompetent woman of a rare case of central nervous system cryptococcal choroid plexitis with trapped temporal horns, enlarged enhancing bilateral choroid plexuses and multiple intraventricular choroid plexus cysts.

Central Nervous System Infection Caused by Cryptococcus

“…In contrast, MRI shows dilated VR spaces with occasional meningeal enhancement in immunocompromised patients (3). The choroid plexus lies between the CSF and the systemic circulation; however, it is an uncommon site of cryptococcal infection (3). In this case, we demonstrated an unusual presentation of cryptococcus with involvement of the choroid plexus.…”

Chronic meningitis: a diagnostic challenge highlighted in a case of cryptococcal meningoencephalitis in an apparently immunocompetent older woman

“…Enzyme immunoassay can be used to detect cryptococcal antigen in CSF as well as serum (blood culture), urine and lung secretions (bronchoalveolar lavage) 11. CT scan may show cerebral oedema, hydrocephalus, cryptococcomas, reveal meningeal enhancement or be normal 7. The antifungal agent amphotericin B used in combination with flucytosine forms the basis of initial treatment followed by long-term secondary prophylaxis with high dose fluconazole.…”

Involvement of the Choroid Plexus in Neurotuberculosis: MR Findings in Six Cases

“…The papillary fronds of the choroid plexus 6,7 . However, it is also not clear whether the tubercular bacilli initially lodge into the choroid plexus by hematogenous spread or extend from adjacent subependymal inflammatory focus of Rich, which eventually ruptures into the ventricle to discharge the bacilli into the CSF 8,9 .…”

“…Similar features of isolated ventricular dilatation are described in cryptococcal choroid plexitis but the inflammatory response and consequent contrast enhancement is much less. Dilated Virchow-Robin spaces filled with budding cryptococci and cryptococcal granulomas have a distinctive imaging pattern as compared to tuberculomas 7,8 .…”