HIV and Cryptococcal Meningitis

by

Cherie O'Brien, M.D.

40 yo man just diagnosed with advanced AIDS with this admission who has a CD4 count of only 12. He presented with severe headaches and CSF showed the cryptococci on india ink. Everything else cultured was negative. That includes AFB, VDRL, etc. First MRI showed nothing bad. He had to get retapped 2 more times for papilledema and bad headaches which correlated with raised ICP and then was doing really well until day 10 when new right central appearing 7th paresis of his face. Repeat MRI with contrast of his brain now shows what looks like cerebritis in bilateral occipital lobes. Bright there as well as the left cerebellum. No visual fields deficits. Now day 14 and no worsening. I just did another L.P. to see whether any improvement or new organism in the CSF.  The MRI images are shown below. Would you give steroids to a patient who may have cerebritis in the setting of cryptococcal meningitis? I've not heard that crypto can cause this?

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