Abstract
BackgroundCryptococcus neoformans is saprophytic encapsulated yeast. Infection is acquired by inhalation of the organism and could be asymptomatic or limited to the lungs, specially in the immunocompetent host. Cryptococcal meningitis is a serious opportunistic infection among post transplant recipients. Cranial nerve palsies and ophthalmoplegia are well known complications of this disease, but bilateral complete ophthalmoplegia is a very rare presentation.Case PresentationA Sri Lankan young male, who is a post kidney transplant recipient, presented with bilateral complete ophthalmoplegia and subsequently was diagnosed to have cryptococcal meningitis based on Indian ink stain and culture of cerebrospinal fluid (CSF). His magnetic resonance imaging (MRI) showed bilateral multiple nodular lesions in both basal ganglia and thalami. Brainstem imaging was normal.ConclusionsCryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. Bilateral thalamic lesions, inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient.
Highlights
Cryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs
Inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient
Apart from that in our review of the literature we found several references to cases of cryptococcal meningitis with numerous combinations of or isolated second, third, fourth, sixth, seventh and eighth cranial neuropathies
Summary
Cryptococcal meningitis is a serious fungal infection in post transplant patients It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. This case illustrates a patient with cryptococcal meningitis with a rare presentation, ie. We have reviewed the literature about previously reported cases of cryptococcal meningitis with cranial neuropathies and ophthalmoplegia. Cranial nerve invasion and inflammation and raised intracranial pressure were thought to be responsible for the clinical presentation of our patient. Apart from that this case reiterates the importance of thalamic lesions in producing vertical and horizontal gaze palsies. All authors read and approved the final version of the manuscript
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