Meningitis Due to Hyphae-Forming Cryptococcus neoformans.

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Cryptococcus neoformans (C. neoformans) is usually described as an encapsulated yeast-like cell. We report a rare case of meningitis due to hyphae-forming C. neoformans.A 53-year-old male was admitted to Sawara Hospital because of fever and headache on July 9, 1991. At the time of admission, there were no abnormal findings or meningeal signs. The laboratory data including the leukocyte-count and C-reactive protein (CRP) showed nothing abnormal. The chest X-ray film showed a few nodular, maculary shadows in bilateral lung areas. The patient was treated with 600mg/day of ofloxacin for 12 days, but this clinical treatment was not sufficient. Although there were no meningeal signs, we examined his cerebrospinal fluid (CSF). Hyphae-forming encapsulated fungi were detected in the CSF by India-ink staining, and were identified as C. neoformans var. neoformans serotype A. The patient was treated with 400mg/day of fluconazole intravenously for 6 days, and the abnormal shadows on his lung X-ray film improved. However, the meningitis was complicated by hydrocephalus, so he was then treated with amphotericin B intravenously and intraventricularly. After 26 days of this therapy, C. neoformans had disappeared on CSF cultures, but it took 69 days for C. neoformans to completely disappear on CSF smears. A ventriculo-peritoneal (VP) shunt was also performed.
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