Difficulty diagnosing chronic cryptococcal meningitis in idiopathic CD4+ lymphocytopenia

Giuseppe Sancesario, Giampiero Palmieri, Gemma Viola, Carla Fontana, Alessandra Perfetti, Lucia Anemona, Roberto Floris, Simone Marziali, Giorgio Bernardi, Luigi Giusto Spagnoli

Research output: Contribution to journalArticle


A 64-year-old man with idiopathic CD4+ lymphocytopenia developed cognitive impairment and gait ataxia with isolated obstructive hydrocephalus, which was fatal. Cerebrospinal fluid showed mild pleocytosis, but the etiology was not revealed by extensive analysis. At autopsy, inflammatory cells, CD8+ lymphocytes and abundant macrophages but not CD4+ lymphocytes were infiltrating the meninges at the base of the brain. Electron microscopy demonstrated that inflammation was caused by Cryptococcus neoformans, which was localized exclusively within macrophages, where it grew with budding. Our study suggests that, in idiopathic CD4? lymphocytopenia, macrophages can efficiently phagocytize but inefficiently digest C. neoformans, thus representing a vehicle of chronic intracellular infection.

Original languageEnglish
Pages (from-to)519-524
Number of pages6
JournalNeurological Sciences
Issue number3
Publication statusPublished - Jun 2011


  • Cryptococcosis
  • Cryptococcus neoformans
  • Electron microscopy
  • Idiopathic CD4 lymphocytopenia
  • Macrophages

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Dermatology

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    Sancesario, G., Palmieri, G., Viola, G., Fontana, C., Perfetti, A., Anemona, L., Floris, R., Marziali, S., Bernardi, G., & Spagnoli, L. G. (2011). Difficulty diagnosing chronic cryptococcal meningitis in idiopathic CD4+ lymphocytopenia. Neurological Sciences, 32(3), 519-524. https://doi.org/10.1007/s10072-011-0496-5