MICROGLIAL NODULE ENCEPHALITIS - LIMITED CNS INFECTION DESPITE DISSEMINATED SYSTEMIC CRYPTOCOCCOSIS

A 28-year-old patient with AIDS was found at autopsy to have dissemina ted cryptococcal infection involving the lungs, spleen, lymph nodes, k idneys, gastrointestinal tract, thyroid, bone marrow, and liver. Despi te widespread organ dissemination the patient did not have clinical or pathological evidence of meningitis. Microscopic examination of the b rain showed cryptococci limited to the brainstem and basal ganglia; mi croglial nodules with multinucleate giant cells, a histological hallma rk of HIV-1 encephalitis, were shown to contain Cryptococcus neoforman s. This feature may suggest a form of synergism between HIV-1 and Cryp tococcus neoformans. This case demonstrates an unusual form of cryptoc occal neurotropism with limited CNS involvement.