First report of concomitant cryptococcal meningitis and anti-NMDAR encephalitis

Sofia R Valdoleiros; Margarida Calejo; António Marinho; Ana Martins da Silva; Olga Vasconcelos; Maria João Gonçalves; Rui Sarmento E Castro

doi:10.1016/j.bbih.2020.100036

First report of concomitant cryptococcal meningitis and anti-NMDAR encephalitis

Brain Behav Immun Health. 2020 Jan 9:2:100036. doi: 10.1016/j.bbih.2020.100036. eCollection 2020 Feb.

Authors

Sofia R Valdoleiros¹, Margarida Calejo², António Marinho^{3

4}, Ana Martins da Silva^{2

4}, Olga Vasconcelos¹, Maria João Gonçalves¹, Rui Sarmento E Castro¹

Affiliations

¹ Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
² Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
³ Department of Internal Medicine, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
⁴ Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4099-001, Porto, Portugal.

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder, seen most often in young adults and children, triggered by tumors or infections. We report a case of cryptococcal meningitis in a patient with sarcoidosis, presenting prominent neuropsychiatric symptoms, electroencephalographic features of autoimmune encephalitis and positive anti-NMDAR antibodies in the cerebrospinal fluid, raising the hypothesis of an infectious immune-mediated mechanism triggering the production of anti-NMDAR antibodies. Since anti-NMDAR encephalitis is potentially fatal and has significant morbidity, further descriptions of its etiological associations are essential to early identification and prompt treatment.

Keywords: Anti-N-Methyl-D-Aspartate receptor; Anti-N-Methyl-D-Aspartate receptor encephalitis; Cryptococcal meningitis; Cryptococcosis; Cryptococcus neoformans; Sarcoidosis.