PMC9489831_01
Results of cerebrospinal fluid (CSF) staining. (A) Wright-Giemsa staining (1,000 X). All cells are eosinophils except the one surrounded by a black circle, which is a lymphocyte. (B) Alcian blue staining (1,000 X). Black arrow = Cryptococcus with an intact capsule. The capsule of Cryptococcus is dark blue and the thallus is light blue.
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F1
A lumbar puncture revealed elevated CSF opening pressure (>330 mmH2O), decreased glucose (1.19 mmol/L), elevated protein (0.96 g/L), and pleocytosis of 358 x 106 leucocytes/L (91% eosinophils, 4% lymphocytes, 4% monocytes, and 1% plasma cells) (Figure 1A). Alcian blue staining revealed Cryptococcus (Figure 1B), and the CSF culture grew Cryptococcus neoformans resistant to fluconazole.
Changes in the leucocyte count and proportion of eosinophils in the cerebrospinal fluid (CSF) with treatment. On the first day of admission, the leukocyte count was 358 x 106/L (91% eosinophils), which decreased to 8 x 106/L (42% eosinophils) after about 8 weeks of antifungal induction therapy, and to 3 x 106/L (2% eosinophils) after 13 weeks of antifungal consolidation therapy combined with tumor chemotherapy.
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F2
CSF culture is still negative, and the leucocyte count and proportion of eosinophils in the CSF have decreased gradually with treatment (Figure 2).