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AJNR - American Journal of Neuroradiology

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Unusual Presentation of Central Nervous System Cryptococcal Infection in an Immunocompetent Patient

Gaurav Saigal^a, M. Judith Donovan Post^a, Sudha Lolayekar^b and Amir Murtaza^c

^a Department of Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
^b Department of Internal Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL
^c Department of Neurology, Jackson Memorial Hospital, University of Miami, Miami, FL

View larger version (70K): [in a new window]   FIG 1. Axial T2-weighted (A) and contrast-enhanced T1-weighted (B) MR images demonstrate a cluster of small hyperintense T2-weighted lesions in the basal ganglia (arrows), showing subtle peripheral enhancement. Diffusion-weighted image (C) demonstrates high signal intensity in some of the lesions (arrow).

View larger version (51K): [in a new window]   FIG 2. India ink preparation of CSF (A) demonstrates encapsulated yeast. CSF mycology culture (B) shows a light growth of Cryptococcus neoformans.

View larger version (131K): [in a new window]   FIG 3. On axial T2-weighted (A) and contrast-enhanced (B) MR images, repeat MR imaging shows marked enlargement of the previously noted cystic lesions in the basal ganglia and florid peripheral postcontrast enhancement of the lesions. New areas of restricted diffusion are seen on the diffusion-weighted (C) and the apparent diffusion coefficient map (D) images, which are different in location from those seen before.

View larger version (99K): [in a new window]   FIG 4. A, Initial thallium–single-photon emission tomography image demonstrates marked uptake in the basal ganglia bilaterally. B, Posttreatment, note near complete reduction of uptake.

View larger version (109K): [in a new window]   FIG 5. Axial T1-weighted (A) and postcontrast T1-weighted (B) images demonstrate T1 hyperintensity in the basal ganglia, suggestive of calcification. Some residual enhancement persists on the postcontrast images.