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Case Reports
. 2012 Jul;15(3):218-20.
doi: 10.4103/0972-2327.99725.

Cryptoccocal menigitis as a primary manifestation in a patient with intestinal lymphangictasia

Shaik Afshan Jabeen  1 , Aruna Murthy, Rukmini Mridula Kandadai, A K Meena, Rupam Borgohain, Megha S Uppin
Affiliations
Case Reports

Cryptoccocal menigitis as a primary manifestation in a patient with intestinal lymphangictasia

Shaik Afshan Jabeen et al. Ann Indian Acad Neurol. 2012 Jul.

Abstract

Opportunistic infections usually occur in patients with an immunocompromised state, and can be severe. Cryptoccocal meningitis is a fatal condition if left untreated, and is usually found in such patients. We report the case of an adult patient with cryptoccocal meningitis secondary to intestinal lymphangiectasia. A 30 year old female was admitted to our hospital for meningitis. Biochemical and radiological investigations were performed. A cerebrospinal fluid latex agglutination test showed positive cryptoccocal antigen. In addition, there were features of humoral and cell mediated immunity deficiency (lymphopenia, hypoalbuminemia, hypogammaglobulinemia), with a negative human immunodeficiency virus (HIV) test by enzyme linked immunosorbent assay and polymerase chain reaction. An upper gastroduodenoscopy was performed, which showed multiple lymphangiectasias, and a biopsy confirmed the diagnosis of primary intestinal lymphangiectasia (PIL). The patient was treated with intravenous amphotericin B and oral flucytosine, and the meningitis resolved. PIL should be suspected in patients with cryptoccocal meningitis, combined with humoral and cell mediated immunity with a negative HIV test. The management issues, in addition to antifungal therapy, include nutritional supplements for the protein losing enteropathy.

Keywords: Cryptoccocal meningitis; cellular and humoral immunity; intestinal lymphangiectasia.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Upper gastrointestinal endoscopy pictures revealing whitish granular appearance of duodenal mucosa with white-tipped villi (open black arrow), scattered white spots, white nodules (solid black arrow) and submucosal elevations (white arrow)
Figure 2
Figure 2
Histopathology of the upper duodenal mucosa with hematoxylin stain shows dilated intramucosal (white arrow) and submucosal lacteals (black arrow)
See this image and copyright information in PMC

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