A 40 years old HIV positive patient presented to the emergency with fever, neck pain and vomiting. He ultimately died and the appearance of the brain at autopsy and the micrograph is shown below. Identify the most likely pathogen involved:
B. Echinococcus multilocularis
C. Herpes meningitis
Ans: D. Cryptococcus
(Ref Robbins 9/e p387-388; Ananthanarayan 10/e p616, 8/e p611: Harrison I9/e p1340)
- Clinical features (Meningoencephalitis) & images (soap bubble lesions in brain parenchyma) suggest cryptococcal yeast infection.
- Most likely pathogen – Cryptococcus.
- Major lesions – In CNS (involving meninges, cortical gray matter & basal nuclei).
- Gelatinous fungal masses grow in meninges or expand perivascular Virchow- Robin spaces within gray matter.
- Producing “soap-bubble lesions”.