Home›Urology› Cryptococcal meningitis with sequential cerebral infarctions and autonomic dysfunction in a non-HIV man with type 2 diabetes
Cryptococcal meningitis with sequential cerebral infarctions and autonomic dysfunction in a non-HIV man with type 2 diabetesAntifungal treatment helps man with diabetes and brain infection
Frontiers in MedicinePublished October 15, 2026Study authors: Lijin Liu, Fanxin Kong, Jinfang Li, Jianjun Wang, Wei Li, Yong Jiang, Lanying Liu, Xiude QinDOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
Consider early CSF investigation when neurological features are discordant with an isolated vascular diagnosis.
This is a case report with a focused literature review describing a 66-year-old non-HIV man with type 2 diabetes mellitus who presented with cryptococcal meningitis. The authors report cerebrospinal fluid findings including an opening pressure greater than 300 mmH2O, leukocytes 128x10^6/L, protein 964 mg/L, and glucose 1.28 mmol/L. The clinical course was complicated by cerebral infarction and autonomic dysfunction.
The patient received antifungal treatment with amphotericin B and fluconazole and experienced substantial clinical improvement. The authors state that the literature review notes sequential infarctions with prominent autonomic syndrome are poorly documented, suggesting this presentation is uncommon or underrecognized.
The main limitation is the small sample size inherent to a case report. Adverse events, follow-up duration, and funding or conflicts of interest were not reported. Because this is a single case, no causal inferences can be drawn and the findings cannot be generalized.
The authors suggest that early CSF investigation may be warranted when recurrent infarction, encephalopathic progression, and multisystem neurological features are discordant with an isolated vascular diagnosis. This is a cautious practice consideration based on one case and a focused literature review, not on comparative or controlled data.
How this fits prior evidence
This case report and focused literature review addresses a gap in the documentation of sequential cerebral infarctions with prominent autonomic syndrome in cryptococcal meningitis, a presentation the authors describe as poorly documented. Prior coverage has focused on cardiovascular and metabolic outcomes in type 2 diabetes, including SGLT-2is and GLP-1RAs reducing heart failure related composite endpoints, structured exercise reducing triglycerides and LDL-C, and mazdutide showing dose-dependent weight and HbA1c reduction. This report does not confirm or extend those findings; it describes an infectious and neurological complication in a patient with type 2 diabetes, a different clinical domain.
When a patient presents with a brain infection and symptoms that look like a stroke, doctors must act quickly to find the true cause. In this case, a 66-year-old man with type 2 diabetes was struggling with a serious infection called cryptococcal meningitis. This type of infection can be very dangerous, especially when it affects the brain.
Doctors treated the man with a combination of two medications: amphotericin B and fluconazole. These are antifungal drugs used to fight the infection. After starting this treatment, the man showed a substantial clinical improvement. His condition stabilized as the medicine worked to clear the infection from his system.
While this was a single case report, it highlights a vital lesson for doctors. When a patient has repeated strokes and neurological issues that do not seem to match a simple vascular problem, it is important to check the spinal fluid. This helps doctors catch hidden infections early and provide the right treatment.
What this means for you:
Antifungal treatment successfully improved a man's condition after he was diagnosed with a brain infection.
Common questions
What medications were used to treat the brain infection?
The patient was treated with a combination of two antifungal medications: amphotericin B and fluconazole. This treatment led to a substantial clinical improvement in his condition.
Who was the patient in this case?
The patient was a 66-year-old man who had type 2 diabetes. He was diagnosed with cryptococcal meningitis, which is a type of infection affecting the brain and spinal cord.
Why is it important to test spinal fluid in these cases?
Testing the cerebrospinal fluid is important when a patient has symptoms like repeated strokes or neurological issues that do not seem to match a simple vascular diagnosis. It helps doctors identify hidden infections early.
Cryptococcal meningitis (CM) can occur in patients without human immunodeficiency virus (HIV) infection and may be complicated by genuine cerebral infarction, creating a powerful diagnostic anchor toward primary cerebrovascular disease. We report a 66-year-old non-HIV man with type 2 diabetes mellitus and no documented major immunosuppressive condition who initially presented with dizziness and mild headache. Brain MRI showed restricted diffusion in the left brainstem, and acute ischemic stroke was diagnosed. Over the following weeks, neurological deterioration continued despite stroke-directed treatment. Repeat MRI demonstrated new infarctions involving the left cerebellar vermis, corpus callosum, and left thalamus, while the patient developed rapid cognitive decline and prominent autonomic manifestations, including orthostatic hypotension, urinary retention, constipation, vomiting, and severe sleep disturbance. Cerebrospinal fluid (CSF) examination revealed an opening pressure >300 mmH2O, leukocytes 128 × 106/L, protein 964 mg/L, and glucose 1.28 mmol/L. India ink staining was suspiciously positive, and Cryptococcus neoformans was confirmed by fungal culture and metagenomic next-generation sequencing. Serial lumbar punctures and antifungal treatment with amphotericin B and fluconazole were followed by substantial clinical improvement. To contextualize the case, we conducted a focused review of published non-HIV or apparently immunocompetent reports of CM-associated cerebral infarction. The literature shows a recurring pattern of deep perforator, brainstem, cerebellar, callosal, and multifocal ischemic injury, with both small- and large-vessel mechanisms reported. However, sequential infarctions across multiple territories accompanied by a prominent progressive autonomic syndrome remain poorly documented. This case supports early CSF investigation when recurrent infarction, encephalopathic progression, and multisystem neurological features are discordant with an isolated vascular diagnosis.
