Cryptococcal Meningoencephalitis with Meningomyelitis: A Case Report

Cryptococcus is a very invasive fungal pathogen that usually involves the central nervous system. Cryptococcal meningomyelitis is very rare, even in patients with AIDS. Cryptococcus infection presenting as a spinal cord syndrome has been reported, but all of these cases were vertebral osteomyelitis. We report on an immunocompetent 49-year-old man with cryptococcal meningoencephalitis associated with thoracic-meningomyelitis and cranial nerve (CN) VI, VII, and VIII involvement. He visited the emergency department with a 10-day history of bilateral temporal headache and fever with chills with paraplegia the previous 2 days. The diagnosis of cryptococcal meningoencephalitis was confirmed by CSF study and brain/cervical spine MRI findings. Thoracic meningomyelitis was suspected because thoracic-lumbar spine MRI showed abnormal enhancement around the conus medullaris and at the spinal nerve roots. This patient also had CN VI and VII palsy and bilateral CN VIII involvement with acute hearing impairment.