From suspected Creutzfeldt-Jakob disease to confirmed histoplasma meningitis

Abstract

A 77-year-old man with chronic obstructive lung disease who was on steroids, presented to the hospital after a fall with subacute headaches and ataxia. During the patient's hospital course, his clinical condition deteriorated with myoclonic jerks, fevers and severe encephalopathy. An extensive workup, including EEG, brain MRI and lumbar puncture, revealed possible Creutzfeldt-Jakob disease. Unfortunately, the patient failed to improve and died 12 days after admission. A brain-only autopsy revealed he had acute histoplasma meningitis with patchy superficial cerebritis.

Figure 1

EEG image showing periodic sharp wave complexes.

Figure 2

MRI fluid attenuated inversion recovery (FLAIR) (A), diffusion (B), T2 (C) weighted image showing unusual symmetrical diffusion restriction and FLAIR hyperintensity in the cingulate gyrus in the cortex of the perisylvian cortex, in the limbic system, including anterior temporal lobe, medial temporal lobe and the medial occipital lobe on the left and right side, as well as the cortical surface of the tectum, medulla, dorsal lateral thalamus, left and right basal ganglia including the caudate nucleus and putamen.

Figure 3

Leptomeninges stained with Grocott methenamine silver stain. There are numerous yeast cells (size 2–4 µm) with budding and with no evidence of hyphae (original magnification, ×600).