The Cerebellar Leptomeningeal Enhancement Associated with Cryptococcal Meningitis.

A 71-year-old male construction worker without human immunodeficiency virus had a headache. He showed meningeal signs and ataxia. His cerebrospinal fluid showed a cell count of 335/μL (60% polymorphonuclear leukocytes) and protein level of 171 mg/dL, with a glucose level of <10 mg/dL. Indian ink staining revealed fungus bodies (Picture 1). Brain magnetic resonance imaging showed enhancement along the cerebellar folia on contrast T1-weighted imaging (Picture 2, 3). Fluid attenuated inversion recovery imaging showed high-intensity areas at the cerebellar hemispheres and cerebellar swelling (Picture 4). Although leptomeningitis is a common cause of cases of non-AIDS-related cryptococcal meningitis (1), this is a rare case of cryptococcal meningitis with leptomeningeal enhancement limited to the cerebellum and no apparent cryptococcoma (2,3). Cryptococcus meningitis should be considered in patients with a high risk of inhaling cryptococcus antigen, even when the lesion is limited to the cerebellum and the patient has no pathological antecedents.

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The authors state that they have no Conflict of Interest (COI).