Cryptococcal Choroid Plexitis with Trapped Ventricle in an Immunocompetent Individual: An Autopsy Case with Systematic Review of Reported Cases

Cryptococcus neoformans causes serious infections of the central nervous system, including meningitis, encephalitis, or cryptococcomas, and is increasingly reported in immunocompetent individuals. Cryptococcal choroid plexitis is a rare entity that often presents with ependymitis and synechiae formation, resulting in "trapped ventricles." Cryptococcomas forming gelatinous pseudocysts manifest as prominent Virchow-Robin spaces and lead to false-negative smear and culture reports, leading to a delay in diagnosis. We report a 37-year-old woman from Assam with chronic headache for 3 months, recurrent seizures, and altered mentation for 15 days. Contrast-enhanced magnetic resonance imaging showed features of choroid plexitis and obstructive hydrocephalus with "trapped" temporal horns of the ventricle. Serum and cerebrospinal fluid cryptococcal antigen were weakly positive, with negative fungal smear and cultures. She was treated with liposomal amphotericin B with flucytosine but developed brainstem herniation and died. Autopsy of the brain revealed bulky choroid plexus with prominent Virchow-Robin spaces and gelatinous pseudocysts. Microscopic examination revealed multiple periventricular microabscesses teeming with cryptococcal organisms. The case, along with a systematic review of similar cases in the literature, highlights the complexities in diagnosing and managing cryptococcal meningoencephalitis in the immunocompetent host.