Cryptococcus gattii meningitis complicated by immune reconstitution inflammatory syndrome in an apparent immunocompetent host in Malaysia

Abstract

Cryptococcosis is a systemic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. Cryptococcus causes a wide range of diseases, ranging from asymptomatic pulmonary lesions to disseminated disease involving the central nervous system, particularly meningoencephalitis. C. gattii infection has rarely been reported in Malaysia. We present a case of C. gattii meningitis with pulmonary cryptococcosis complicated by immune reconstitution inflammatory syndrome in an apparently immunocompetent person with no prior travel history.

Keywords: Cryptococcosis; Cryptococcus gattii; Immune reconstitution inflammatory syndrome; Pulmonary cryptococcosis.

Fig. 1

Microscopic morphology of Cryptococcus from the CSF sample (a) Spherically-budded yeast cell surrounded by non-staining thick capsule on Gram stain. (b) Rounded yeasts surrounded by thick capsule (clear outermost layer of the organism) on India ink.

Fig. 2

High-resolution CT of the thorax (a) coronal view, (b) axial view, showing a well-defined lung nodule at the superior segment of the right lower lobe.

Fig. 3

MRI of the brain showing presence of cryptococcomas at bilateral basal ganglia (indicated by arrows), dilated perivascular spaces, and mild dilatation of all ventricles suggestive of communicating hydrocephalus.