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LETTER TO EDITOR  
Year : 2015  |  Volume : 7  |  Issue : 3  |  Page : 123-124
Cryptococcal meningitis with multiple cranial nerves palsies: A review of literature


Department of Medicine IV, Christian Medical College, Vellore, Tamil Nadu, India

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Date of Web Publication18-Aug-2015
 

How to cite this article:
Krishnamoorthy A, Joel A, Abhilash KP. Cryptococcal meningitis with multiple cranial nerves palsies: A review of literature. J Global Infect Dis 2015;7:123-4

How to cite this URL:
Krishnamoorthy A, Joel A, Abhilash KP. Cryptococcal meningitis with multiple cranial nerves palsies: A review of literature. J Global Infect Dis [serial online] 2015 [cited 2019 Jun 27];7:123-4. Available from: http://www.jgid.org/text.asp?2015/7/3/123/161739


Sir,

Cryptococcal meningitis (CM) is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection. If untreated, it is invariably fatal with 30-82% mortality. [1] Cranial nerve palsies are seen in about 25% of patients and usually involves a single cranial nerve, most commonly the abducens nerve. Involvement of multiple cranial nerves is very unusual. We report a 20-year-old lady who presented with multiple cranial nerve palsies due to CM as the first presentation of HIV infection. She had headache since 2 months and altered behavior since 2 days. Cranial nerves involved were the second, sixth, and seventh in the form of decreased visual acuity bilaterally, bilateral lateral rectus palsy, and left upper motor neuron facial palsy. Cerebrospinal fluid fungal culture grew colonies of Cryptococcus neoformans. Perineuritic adhesive arachnoiditis due to CM has been shown as the cause for cranial nerve palsies in autopsy studies. [2] A review of literature is shown in [Table 1].
Table 1: Reported cranial nerve involvement in CM (1985-2013)

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[10]

 
   References Top

1.
Pyrgos V, Seitz AE, Steiner CA, Prevots DR, Williamson PR. Epidemiology of Cryptococcal Meningitis in the US: 1997-2009. PLoS One 2013;8:e56269.  Back to cited text no. 1
    
2.
Lipson BK, Freeman WR, Beniz J, Goldbaum MH, Hesselink JR, Weinreb RN, et al. Optic neuropathy associated with cryptococcal arachnoiditis in AIDS patients. Am J Ophthalmol 1989;107:523-7.  Back to cited text no. 2
    
3.
Sadun F, De Negri AM, Santopadre P, Pivetti Pezzi P. Bilateral trochlear nerve palsy associated with cryptococcal meningitis in human immunodeficiency virus infection. J Neuroophthalmol 1999;19:118-9.  Back to cited text no. 3
    
4.
Mohan S, Ahmed SI, Alao OA, Schliep TC. A case of AIDS associated cryptococcal meningitis with multiple cranial nerve neuropathies. Clin Neurol Neurosurg 2006;108:610-3.  Back to cited text no. 4
    
5.
Cohen DB, Glasgow BJ. Bilateral optic nerve cryptococcosis in sudden blindness in patients with acquired immune deficiency syndrome. Ophthalmology 1993;100:1689-94.  Back to cited text no. 5
    
6.
Kwok SK, Seo SH, Ju JH, Yoon CH, Park SC, Kim BS, et al. Cryptococcal meningitis presenting with isolated sixth cranial nerve palsy in a patient with systemic lupus erythematosus. J Korean Med Sci 2008;23:153-5.  Back to cited text no. 6
    
7.
Tjia TL, Yeow YK, Tan CB. Cryptococcal meningitis. Occasional review. J Neurol Neurosurg Psychiatry 1985;48:853-8.  Back to cited text no. 7
[PUBMED]    
8.
Mahadevan A, Kumar A, Santosh V, Satishchandra P, Shankar SK. Multiple cranial nerve involvement in cryptococcal meningitis. Ann Indian Acad Neurol 2000;3:33-7.  Back to cited text no. 8
  Medknow Journal  
9.
Leite AG, Vidal JE, Bonasser Filho F, Nogueira RS, Oliveira AC. Cerebral infarction related to cryptococcal meningitis in an HIV-infected patient: Case report and literature review. Braz J Infect Dis 2004;8:175-9.  Back to cited text no. 9
    
10.
Prada JL, Cisneros JT, Kindelan JM, Jurado R, Villanueva JL, Navarro M, et al. Deafness and blindness in a HIV-positive patient with cryptococcal meningitis. Postgrad Med J 1996;72:851.  Back to cited text no. 10
    

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Correspondence Address:
Kundavaram Paul Prabhakar Abhilash
Department of Medicine IV, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.161739

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