Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non-immunocompromised child

Cryptococcal meningitis is one of the most common life-threatening, invasiv e fungal infections of the central nervous system in patients with defectiv e T-lymphocyte function. It is, however, unusual in children. We report on a non-immunocompromised 10-y-old boy without evidence of immunological abno rmality who developed headache, vomiting, disturbances of consciousness and areflexia. Magnetic resonance imaging of the brain and the spinal cord rev ealed enlargement of the ventricles and high signal lesions in the leptomen inges at the level of the cerebral peduncles and the cervical and thoracic cord. Cerebrospinal fluid analysis was positive for Cryptococcus neoformans . He was treated with amphotericin B and was symptom-free within 1 wk. Desp ite an extended course of therapy his symptoms suddenly relapsed and he suc cumbed to the medical complications of cardiac and respiratory failure. Cen tral nervous system appearances at postmortem were those of cryptococcal le ptomeningitis.