PMC9424585_01
Initial and follow-up MRI brain. T1-weighted (A), T1-weighted with gadolinium (B), T2-weighted (C, D, H), diffusion-weighted images (DWI) (E), apparent diffusion coefficient (ADC) (F), and T2-fluid-attenuated inversion recovery (FLAIR) (G).
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No neurological deficits were found at the time but further investigation with magnetic resonance imaging (MRI) of the brain showed a 2-cm heterogeneous enhancing cystic lesion at the right thalamus (Fig. 1). Another MRI of the brain was done 2 weeks after the previous MRI and showed a similar cystic lesion, probably cryptococcoma (Fig. 1).
India ink preparation of the cerebrospinal fluid. At 40x magnification (Left) and 100x magnification (Right), showing encapsulated budding yeast cells and a few single yeast cells without budding morphology, demonstrating Cryptococcus. The polysaccharide capsule surrounding the cell results in the appearance of a halo around the cell under India ink preparation.
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Cryptococcal antigen was positive with a titer of 1:2048 and encapsulated budding yeast was seen from India ink examination (Fig. 2). CSF fungal culture revealed Cryptococcus gattii.