Undiagnosed cryptococcal meningoencephalitis with extensive hypoxic-ischemic brain injury mimicking grade 3 diffuse axonal injury

Česká verzia

Authors: Daniel Farkaš ¹; Anna Kružlíková ²; Jana Němcová ³; Vladimír Hrabovský ⁴; Silvia Farkašová Iannaccone ⁵; Alžbeta Ginelliová ¹; Lucia Fröhlichová ⁶; Marián Švajdler ³
Authors place of work: Úrad pre dohľad nad zdravotnou starostlivosťou, SLaPA pracovisko, Košice ¹; Úrad verejného zdravotníctva Slovenskej republiky, Bratislava ²; Bioptická laboratoř s. r. o., Plzeň ³; Ústav lekárskej a klinickej mikrobiológie UPJŠ LF, Košice ⁴; Ústav súdneho lekárstva UPJŠ LF, Košice ⁵; Oddelenie patológie, Univerzitná nemocnica Louisa Pasteura, Košice ⁶
Published in the journal: Čes.-slov. Patol., 57, 2021, No. 3, p. 167-173
Category: Original Articles

Summary

In this article, we report the autopsy findings of a 50-year-old immunocompetent woman, who was hospitalized with an altered state of consciousness. Examinations, including cerebrospinal fluid analysis, carried out during hospitalization failed to identify the infectious agent causing progressive loss of consciousness and quadriparesis. The patient died within 8 days of admission to the hospital. Post-mortem microscopic and culture examination revealed Cryptococcus species. Death was attributed to cryptococcal meningoencephalitis. Histologic examination revealed accumulation of cryptococcus mimicking erythrocytes and extensive hemorrhage in hematoxylin and eosin-stained sections of the brain. Multifocal obliteration of the vascular bed by yeast was accompanied by hypoxic-ischemic brain injury mimicking traumatic diffuse axonal injury.

Keywords:

cryptococcal meningoencephalitis – Cryptococcus – diffuse axonal injury – hypoxic-ischemic brain injury

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