Cryptococcus neoformans脳髄膜炎に多発脳梗塞を合併した非HIV患者の剖検例

抄録

While the association of Cryptococcus neoformans meningoencephalitis with cerebral infarction is widely known, the underlying mechanism remains unknown. We encountered an 82-year-old male patient with C. neoformans meningoencephalitis, associated with multiple cerebral infarctions. Even during treatment with liposomal amphotericin B and flucytosine, the patient developed a new infarction in the pons. The patient eventually died of aspiration pneumonia. Autopsy revealed C. neoformans infiltrating the perivascular spaces of the perforating branches of the middle cerebral and basilar artery regions, with inflammation and thrombotic occlusions of these vessels. This case serves to highlight the fact that it is the thrombosis caused by the significant perivascular inflammation, and not infiltration of the vessels by C. neoformans itself, that plays the major role in the pathogenesis of cerebral infarction in non-HIV patients with C. neoformans meningoencephalitis.