Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report

BMC Research Notes

Ranjani Gamage¹  Priyankara WS Perera¹  Manjula HPC Caldera¹  Inuka K Gooneratne¹  Lakmini PS Pathberiya¹  Damith S Liyanage¹ 

[1] Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka

关键词: Thalamic lesions;    Complete ophthalmoplegia;    Cryptococcal meningitis;   

Others  :  1132653
DOI  :  10.1186/1756-0500-7-328

 received in 2013-12-22, accepted in 2014-05-28,  发布年份 2014

【 摘 要 】

Background

Cryptococcus neoformans is saprophytic encapsulated yeast. Infection is acquired by inhalation of the organism and could be asymptomatic or limited to the lungs, specially in the immunocompetent host. Cryptococcal meningitis is a serious opportunistic infection among post transplant recipients. Cranial nerve palsies and ophthalmoplegia are well known complications of this disease, but bilateral complete ophthalmoplegia is a very rare presentation.

Case Presentation

A Sri Lankan young male, who is a post kidney transplant recipient, presented with bilateral complete ophthalmoplegia and subsequently was diagnosed to have cryptococcal meningitis based on Indian ink stain and culture of cerebrospinal fluid (CSF). His magnetic resonance imaging (MRI) showed bilateral multiple nodular lesions in both basal ganglia and thalami. Brainstem imaging was normal.

Conclusions

Cryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. Bilateral thalamic lesions, inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient.

【 授权许可】

   
2014 Liyanage et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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