Patient case - AIDS Complicated Intracranial Cryptococcosis

 

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a male aged 38 years, who had history of paid

blood donation in the year of 1994. He was definitely diagnosed in Feb. 2003 and episodes of

illness in Feb. 2004. He had symptoms of headache, dizziness, nausea with no fever in the year

of 2003. His CD4 count was 37 cells/µl.

 

Imaging demonstrations

Fig. 2-7-3 A                                                                             Fig. 2-7-3 E                       

                                                

Fig. 2-7-3 A,B,C,D,E,F  Axial MR imaging demonstrating multiple punctiform and flaky high T1 and high T2

signals in bilateral hypothalamus and cerebral basal ganglia region with clearly-defined borders, no obvious

space-occupying effect and no obvious edema.

Fig. 2-7-3 G,H,I,J  Sagittal and coronal imaging demonstrating multiple punctiform and flaky

high T1 signal in bilateral hypothalamus and cerebral basal ganglia region with clearly-defined

borders, no obvious edema and no obvious space-occupying effect. 

Fig. 2-7-3 K  MRA demonstrating general stenosis of intracephalic arteries with decreased

blood flow signaling, especially bilateral cerebral middle-sized arteries and right occipital large

arteries.

 

Diagnosis

AIDS complicated cryptococcosis.

 

Discussion

Cryptococcus is a species of opportunistic pathogenic bacteria and cryptococcosis has an

occurrence of 2%~7.5% among immunocompromised population. Autopsy has proved that

Cryptococcus commonly invades meninges, followed by the involvement of basal brain along

lenticulostriate artery and thalamus perforating artery with the prolonged illness course. For this

case, the patient suffered from slight clinical symptoms of headache, dizziness and no fever.

MR imaging demonstrates bilaterally symmetrical multiple punctiform flaky high T1 signal and

high T2 signal in areas of thalamus and basal ganglia. Contrast-enhanced CT scanning and MR

imaging has no findings of enhancement. The imaging demonstrations are related to low level

immunity and absence of inflammatory reactions. Cryptococcosis of this case should be

differentiated from multiple intracephalic infarction that usually has bilaterally unsymmetrical

infarction lesions, different sized new foci from that of old foci and clinically functional

disturbance of contralateral extremities. Based on the combination of clinical manifestations

and lab findings, diagnosis can be made.