Short-term corticosteroid pulse therapy in the treatment of post-infectious spinal arachnoiditis following cryptococcal meningoencephalitis: A case report

Abstract

Cryptococcus meningoencephalitis is increasing in human immunodeficiency virus (HIV)-negative patients, especially in Asian population. In patients who respond well to anti-cryptococcal therapy, some later developed muscle atrophy and weakness. The possibility of spinal arachnoiditis raised. We reported a 65-year-old man with DM, HTN, diagnosed with cryptococcal meningoencephalitis. He underwent a long duration of admission and was finally successfully discharged with salvage consolidation treatment. Despite getting good infection control, he had progressive flaccid paraplegia with profound atrophy, sphincter dysfunction and lower back pain. He was re-admitted and diagnosed with adhesive arachnoiditis after comprehensive studies of spinal cord MRI and CSF sampling. We applied short-term steroid pulse therapy and he had significant neurological improvement without relapsing of his cryptococcal meningoencephalitis. He is currently under rehabilitation programme. The diagnosis of cryptococcal spinal arachnoiditis comorbid with cryptococcal meningoencephalitis is often overlooked because the specific symptoms of bladder dysfunction and gait disturbance might be caused by increased intracranial pressure as well. Our report may give hints to other neurologist facing with these patients, aiming for earlier diagnosis, treatment and better prognosis.

Keywords

• Cryptococcal meningoencephalitis
• Spinal arachnoiditis
• Gait disturbance
• Hydrocephalus
• Upper motor neuron signs
• Lower motor neuron signs