case_images: PMC11072183_01
case_images: Imaging manifestations of Case 1 on cranial MRI. The T2 Flair sequence is as follows: Images (A, B) display small patchy abnormal signal foci symmetrically located at the base of the bilateral basal ganglia on January 4th. Images (C, D) reveal multiple abnormal signal shadows on the cranial MRI on January 10th, including the bottom of the bilateral basal ganglia (a, c), the globus pallidus (e), the cingulate gyrus of the temporal lobe (d), the left edge of the third ventricle (f), and the cerebral aqueduct (b).
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case_images: PMC11072183_01_fimmu-15-1361277-g001.jpg
case_images: f1
case_images: The head magnetic resonance imaging (MRI) revealed a potential brain-related condition as shown in  Figure 1 .
case_images: PMC11072183_02
case_images: The presentation of cerebral infarction in Case 2 on the MRI images. Panel (A-C) represents the examination results from April 30th. In Panel (A), the diffusion-weighted imaging (DWI) sequence shows punctate high signal foci adjacent to the left lateral ventricle, indicating acute cerebral infarction. In Panel (B), T2 Flair sequence reveals patchy high signals adjacent to the right lateral ventricle. In Panel (C), T2 Flair sequence shows patchy high signals adjacent to the right lateral ventricle. Panel (D-F) represents the examination results from May 23rd. In Panel (D), T2 Flair sequence reveals punctate high signals adjacent to the right lateral ventricle. In Panel (E), the T2 Flair sequence demonstrates patchy high signal intensities adjacent to the left lateral ventricle, particularly in the posterior horn region. In Panel (F), there are also patchy high signal areas observed near the left lateral ventricle on the T2 Flair sequence.
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case_images: PMC11072183_02_fimmu-15-1361277-g002.jpg
case_images: f2
case_images: The head MRI revealed an acute cerebral infarction adjacent to the left lateral ventricle, as shown in  Figure 2 . accompanied by increased intracranial pressure of 400+ mmHg (normal range: 80-180 mmHg).
case_images: (A) displays CSF stained with India ink, magnified 1000x. Due to the lack of staining on the capsule, Cryptococcus appears as a "starry sky" against the ink background, with transparent spore bodies and prominent, thick capsules. (B) displays the CSF stained with Wright-Giemsa staining at a magnification of 1000x. Cryptococcus spores display an irregular size and may present as either circular or "8"-shaped structures, showing staining in various hues of purple-black or mauve. Spore bodies show purple-black or mauve pigmentation, while their enclosing capsules are either lightly pigmented or colorless. Prior to treatment, the spores exhibit vigorous growth, with radial fluff covering their surface, as indicated by the black arrows. The dense fluff is prone to contamination by residual dyes, which are difficult to remove, as indicated by the red arrow. (C) displays a Gram-stained smear of a positive blood culture from one side, magnified 400x. In the image, fungal spores are clearly visible, as indicated by the black arrows. These spores have a smooth surface and lack capsules. India ink staining yielded a negative result, but identification following inoculation on blood agar confirmed the presence of Cryptococcus neoformans.
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case_images: PMC11072183_02_fimmu-15-1361277-g003.jpg
case_images: f3
case_images: CSF revealed the detection of Cryptococcus neoformans. Cryptococcus neoformans was detected in blood culture, as depicted in  Figure 3 . Gram staining revealed fungal spores, as shown in  Figure 3C .
case_images: Timeline of changes in the condition of the two cases. (A) provides an illustration of how the symptoms and overall disease condition of case 1 evolved over time with increasing duration of hospital stay, along with depicting the implemented therapeutic interventions during this period; (B) shows the application of treatment plans and changes in disease condition over time for case 2 during hospitalization.
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case_images: f4
case_images: The treatment timelines for Case 1 and Case 2 are shown in  Figure 4 .