Case 104. Cryptococcal meningitis (67 y-o M)
         
    Prolonged meningitis seen in a patient with autoimmune hemolytic anemia receiving corticosteroid    
         
   
Key words : 
Cryptococcus neoformans, cryptococcal meningitis, steroid, India ink test    
         
   
opportunistic infection
   
     
 
     
At the base of brain, mild granulomatous reaction is discerned in the subarachnoid space. The presence of yeast-like pathogens is not so distinctive in H&E preparation. Clinically, the etiology of meningitis was unclear. At autopsy, a cryptococcal granuloma of the lung was identified.   PAS stain clearly demonstrates yeast form fungi in the multinucleated giant cells, confirming the diagnosis of cryptococcal meningitis.
     
 
     
Reference case 104A
Another immunosuppressed adult case of cryptococcal meningitis showing a pronounced dissemination pattern (mucicarmine). In this case, subarachnoidal dissemination of C. neoformans is evident, and most of the fungi are not phagocytized.
  Reference case 104B
Cytological examination of the cerebrospinal fluid reveals a capsule-forming yeast phagocytized by the macrophage (Papanicolaou). Careful screening is needed for the cytological diagnosis of cryptococcal meningitis, since yeast-type pathogens are usually very few in number.
     
   
     
Reference case 104B
India ink test clearly identifies thick-encapsulated yeasts in the cerebrospinal fluid. The risk for cryptococcosis is increased when the cell-mediated immunity is impaired (such as steroid administration and AIDS). Neutropenia does not increase the risk.