Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

Intern Med. 2020 Sep 15;59(18):2301-2306. doi: 10.2169/internalmedicine.4629-20. Epub 2020 Jun 9.


We herein report a 50-year-old man with alcoholic cirrhosis who developed loss of consciousness and tremor of the upper limbs. Magnetic resonance imaging findings were suggestive of limbic encephalitis with bilateral hippocampal damage, and a cerebrospinal fluid (CSF) examination confirmed anti-N-methyl-D-aspartate (NMDA) and anti-glutamate receptor antibodies. Despite initial corticosteroid therapy, meningeal irritation symptoms appeared, owing to the development of cryptococcal meningitis (CM), diagnosed by the detection of cryptococcal capsular polysaccharide antigen in the follow-up CSF analysis. Cerebral infarction with reversible stenosis of major cerebral arteries during the clinical course was also observed. Following administration of antifungals and corticosteroids, the number of cells in the CSF gradually declined, and NMDA receptor antibodies disappeared. Our study demonstrates the unique coexistence of CM with anti-NMDA receptor encephalitis in adults.

Keywords: NMDA receptor; cerebral infarction; cryptococcal meningitis; glutamate receptor (GluR); limbic encephalitis.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / pathology
  • Antifungal Agents / therapeutic use
  • Cerebral Infarction / complications
  • Humans
  • Limbic Encephalitis / complications
  • Magnetic Resonance Imaging
  • Male
  • Meningitis, Cryptococcal / complications*
  • Meningitis, Cryptococcal / drug therapy
  • Meningitis, Cryptococcal / pathology
  • Middle Aged
  • Receptors, Glutamate
  • Receptors, N-Methyl-D-Aspartate / immunology


  • Adrenal Cortex Hormones
  • Antifungal Agents
  • Receptors, Glutamate
  • Receptors, N-Methyl-D-Aspartate