Difficulty diagnosing chronic cryptococcal meningitis in idiopathic CD4(+) lymphocytopenia

作者：Sancesario Giuseppe^*; Palmieri Giampiero; Viola Gemma; Fontana Carla; Perfetti Alessandra; Anemona Lucia; Floris Roberto; Marziali Simone; Bernardi Giorgio; Spagnoli Luigi Giusto

来源：Neurological Sciences, 2011, 32(3): 519-524.

DOI：10.1007/s10072-011-0496-5

• Cryptococcosis
• Cryptococcus neoformans
• Idiopathic CD4 lymphocytopenia
• Macrophages
• Electron microscopy

A 64-year-old man with idiopathic CD4(+) lymphocytopenia developed cognitive impairment and gait ataxia with isolated obstructive hydrocephalus, which was fatal. Cerebrospinal fluid showed mild pleocytosis, but the etiology was not revealed by extensive analysis. At autopsy, inflammatory cells, CD8(+) lymphocytes and abundant macrophages but not CD4(+) lymphocytes were infiltrating the meninges at the base of the brain. Electron microscopy demonstrated that inflammation was caused by Cryptococcus neoformans, which was localized exclusively within macrophages, where it grew with budding. Our study suggests that, in idiopathic CD4(+) lymphocytopenia, macrophages can efficiently phagocytize but inefficiently digest C. neoformans, thus representing a vehicle of chronic intracellular infection.

• 出版日期2011-6