case_images: PMC9489831_01
case_images: Results of cerebrospinal fluid (CSF) staining. (A) Wright-Giemsa staining (1,000 X). All cells are eosinophils except the one surrounded by a black circle, which is a lymphocyte. (B) Alcian blue staining (1,000 X). Black arrow = Cryptococcus with an intact capsule. The capsule of Cryptococcus is dark blue and the thallus is light blue.
case_images: fneur-13-898525-g0001.jpg
case_images: PMC9489831_01_fneur-13-898525-g0001.jpg
case_images: F1
case_images: A lumbar puncture revealed elevated CSF opening pressure (>330 mmH2O), decreased glucose (1.19 mmol/L), elevated protein (0.96 g/L), and pleocytosis of 358 x 106 leucocytes/L (91% eosinophils, 4% lymphocytes, 4% monocytes, and 1% plasma cells) (Figure 1A). Alcian blue staining revealed Cryptococcus (Figure 1B), and the CSF culture grew Cryptococcus neoformans resistant to fluconazole.
case_images: Changes in the leucocyte count and proportion of eosinophils in the cerebrospinal fluid (CSF) with treatment. On the first day of admission, the leukocyte count was 358 x 106/L (91% eosinophils), which decreased to 8 x 106/L (42% eosinophils) after about 8 weeks of antifungal induction therapy, and to 3 x 106/L (2% eosinophils) after 13 weeks of antifungal consolidation therapy combined with tumor chemotherapy.
case_images: fneur-13-898525-g0002.jpg
case_images: PMC9489831_01_fneur-13-898525-g0002.jpg
case_images: F2
case_images: CSF culture is still negative, and the leucocyte count and proportion of eosinophils in the CSF have decreased gradually with treatment (Figure 2).