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We report a previously healthy 82-year-old male with cryptococcal meningitis (CM) who represented neurological deterioration due to post-infectious inflammatory response syndrome (PIIRS) occurring in 4 months after initial antifungal therapy. He was treated with corticosteroids for 2 months and recovered clinically. However, the clinical manifestation, cerebrospinal fluid (CSF), and brain magnetic resonance imaging (MRI) results got worse again on the next day after corticosteroid withdrawal. The analysis of inflammatory cytokines and culture on CSF, as well as brain MRI, still suggested a diagnosis of PIIRS. Therefore, corticosteroid therapy was used again and he subsequently obtained a complete resolution of symptoms.

To explore the brain volume (BV) changes of HIV-negative and non-transplant cryptococcal meningitis (CM) in one year after initial therapy. Case data were collected from 78 CM patients who underwent magnetic resonance imaging (MRI) scanning at least 3 times in one-year interval after initial therapy. The assessment of BV was measured by a non-commercial software, uAI Research Portal. Linear mixed model was used to investigate the association between clinical characteristics and the changes of BV. Longitudinal study showed a decrease in total brain volume (-4.65 cm3, p = 0.005), regional brain volume including white matter (-2.86 cm3, p = 0.031) and basal ganglia (-0.25 cm3, p = 0.007), and an increase in cerebrospinal fluid (CSF) volume (3.58 cm3, p = 0.013) in CM patients in one year after initial therapy. Ventricular volume in patients with ventriculoperitoneal shunts (VPS) was lower than that in patients without VPS (-7.5 cm3, p < 0.05). Ventricular volume in patients with post-infectious inflammatory response syndrome (PIIRS) was larger than that in patients without PIIRS (7.1 cm3, p < 0.01). In addition, temporal lobe atrophy was associated with corticosteroid therapy (-6.8 cm3, p < 0.01). The present study suggested that brain atrophy, especially regional BV decrease, could happen in the HIV-negative and non-transplant CM patients over a one-year interval.

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