Cryptococcal Meningitis with Multiple Cranial Nerves Palsies: A Review of Literature.

Sir,

Cryptococcal meningitis (CM) is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection. If untreated, it is invariably fatal with 30–82% mortality.[1] Cranial nerve palsies are seen in about 25% of patients and usually involves a single cranial nerve, most commonly the abducens nerve. Involvement of multiple cranial nerves is very unusual. We report a 20-year-old lady who presented with multiple cranial nerve palsies due to CM as the first presentation of HIV infection. She had headache since 2 months and altered behavior since 2 days. Cranial nerves involved were the second, sixth, and seventh in the form of decreased visual acuity bilaterally, bilateral lateral rectus palsy, and left upper motor neuron facial palsy. Cerebrospinal fluid fungal culture grew colonies of Cryptococcus neoformans. Perineuritic adhesive arachnoiditis due to CM has been shown as the cause for cranial nerve palsies in autopsy studies.[2] A review of literature is shown in Table 1. [10]

Table 1

Reported cranial nerve involvement in CM (1985–2013)