Cryptococcal Meningoencephalitis with Possible Clinical-Manometric Intracranial Pressure Dissociation in a Pediatric Patient.
- 1Pediatric Infectious Diseases Service, University Hospital of the Federal University of Maranhão (HU-UFMA), Sao Luis 65070-020, Brazil.
Abstract
A 12-year-old previously healthy girl without an identified immunodeficiency presented with a 25-day history of headache, vomiting, and severe asthenia. Cerebrospinal fluid (CSF) analysis confirmed Cryptococcus gattii meningoencephalitis. Despite consistently normal intracranial pressure (ICP) readings on serial lumbar punctures (all below 20 cm H₂O), the patient developed clinical signs suggestive of raised intracranial pressure, progressing to decreased consciousness requiring ICU admission and orotracheal intubation. Brain MRI demonstrated communicating hydrocephalus, leptomeningeal enhancement, and perineural contrast enhancement of the optic nerve sheath and of cranial nerves VII and VIII. Management included an external lumbar subarachnoid drain for CSF drainage and antifungal induction with liposomal Amphotericin B combined with Flucytosine, in accordance with the 2024 ECMM/ISHAM/ASM Global Guideline for non-HIV CNS cryptococcosis. Notwithstanding treatment, the patient developed irreversible amaurosis and bilateral sensorineural hearing loss attributed to perineural leptomeningeal dissemination, confirmed on MRI. This case illustrates a possible clinical-manometric ICP dissociation in pediatric cryptococcal meningoencephalitis-a phenomenon that may reflect adhesive arachnoiditis with spinal CSF compartmentalization rather than true ICP elevation-and underscores the importance of multimodal assessment beyond intermittent manometry in this setting.
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BibTeX
@article{pessoa2026cryptococcal,
title = {{Cryptococcal Meningoencephalitis with Possible Clinical-Manometric Intracranial Pressure Dissociation in a Pediatric Patient.}},
author = {Fabrício Silva Pessoa and Valéria Maciel Costa and Izabel Athayde da Silva Cruz Salgado},
journal = {Pediatric reports},
year = {2026},
month = sep,
doi = {10.3390/pediatric18050125},
url = {https://europepmc.org/article/MED/42931095},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cryptococcal Meningoencephalitis with Possible Clinical-Manometric Intracranial Pressure Dissociation in a Pediatric Patient.
AU - Fabrício Silva Pessoa
AU - Valéria Maciel Costa
AU - Izabel Athayde da Silva Cruz Salgado
PY - 2026
DA - 2026/09/24
JO - Pediatric reports
DO - 10.3390/pediatric18050125
UR - https://europepmc.org/article/MED/42931095
AB - A 12-year-old previously healthy girl without an identified immunodeficiency presented with a 25-day history of headache, vomiting, and severe asthenia. Cerebrospinal fluid (CSF) analysis confirmed Cryptococcus gattii meningoencephalitis. Despite consistently normal intracranial pressure (ICP) readings on serial lumbar punctures (all below 20 cm H₂O), the patient developed clinical signs suggestive of raised intracranial pressure, progressing to decreased consciousness requiring ICU admission and orotracheal intubation. Brain MRI demonstrated communicating hydrocephalus, leptomeningeal enhancement, and perineural contrast enhancement of the optic nerve sheath and of cranial nerves VII and VIII. Management included an external lumbar subarachnoid drain for CSF drainage and antifungal induction with liposomal Amphotericin B combined with Flucytosine, in accordance with the 2024 ECMM/ISHAM/ASM Global Guideline for non-HIV CNS cryptococcosis. Notwithstanding treatment, the patient developed irreversible amaurosis and bilateral sensorineural hearing loss attributed to perineural leptomeningeal dissemination, confirmed on MRI. This case illustrates a possible clinical-manometric ICP dissociation in pediatric cryptococcal meningoencephalitis-a phenomenon that may reflect adhesive arachnoiditis with spinal CSF compartmentalization rather than true ICP elevation-and underscores the importance of multimodal assessment beyond intermittent manometry in this setting.
SN - 2036-749X
SN - 2036-7503
ER -