{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:27:12Z","timestamp":1786663632286,"version":"build-2736575974"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cryptococcus meningoencephalitis (CM) is the most frequently encountered manifestation of cryptococcosis. We report the case of a previously healthy, human immunodeficiency virus (HIV)-negative 65-year-old man who presented with 3 days of severe holocranial headache followed by sudden psychomotor agitation, confusion, and disorganized speech, without improvement after midazolam, requiring endotracheal intubation. Initial neuroimaging suggested inactive neurocysticercosis. Early cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with negative India ink but positive cryptococcal antigen (latex agglutination), and subsequent testing confirmed Cryptococcus neoformans. The patient received fluconazole and amphotericin B and underwent therapeutic lumbar punctures for intracranial pressure control, with opening pressures decreasing from 25 to 13\u2009cmH2O and transient clinical improvement. Despite this response, he experienced sudden deterioration and died. Autopsy revealed diffuse cerebral edema and granulomatous adrenal involvement. This case illustrates the potential fulminant course of cryptococcal meningoencephalitis in immunocompetent individuals and reinforces the importance of early recognition and aggressive intracranial pressure management.<\/jats:p>","DOI":"10.1055\/s-0046-1827160","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:40:03Z","timestamp":1786660803000},"page":"001-006","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant cryptococcal meningoencephalitis with adrenal involvement in an immunocompetent patient: a clinicopathologic correlation"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2224-3762","authenticated-orcid":false,"given":"Luiza Barbosa de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica\/ Unidade do Sistema Nervoso, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2234-3445","authenticated-orcid":false,"given":"Thr\u00edcia Christina Garcia Diniz","family":"Rezende","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4976-7897","authenticated-orcid":false,"given":"Isadora Lyrio","family":"St\u00e1bille","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica\/ Unidade do Sistema Nervoso, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4785-3425","authenticated-orcid":false,"given":"Ruben Luis de Avelino","family":"Carneiro","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Patologia, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5202-0013","authenticated-orcid":false,"given":"Felipe Coelho","family":"Batista","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Patologia, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2563-8225","authenticated-orcid":false,"given":"Jo\u00e3o Henrique do Amaral e","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Patologia, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0999-0165","authenticated-orcid":false,"given":"Alex Eduardo da","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal do Tri\u00e2ngulo Mineiro, Hospital das Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica\/ Unidade do Sistema Nervoso, Uberaba MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1007\/s12024-021-00400-1","article-title":"Cryptococcosis and unexpected death","volume":"17","author":"A Tu","year":"2021","journal-title":"Forensic Sci Med Pathol"},{"issue":"05","key":"ref2","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1086\/322597","article-title":"Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy","volume":"33","author":"P G Pappas","year":"2001","journal-title":"Clin Infect Dis"},{"key":"ref3","volume-title":"Guia de Vigil\u00e2ncia em Sa\u00fade","author":"Brasil. Minist\u00e9rio da Sa\u00fade. Secretaria de Vigil\u00e2ncia em Sa\u00fade. Departamento de Articula\u00e7\u00e3o Estrat\u00e9gica de Vigil\u00e2ncia em Sa\u00fade","year":"2022","edition":"5\u00aa ed."},{"key":"ref4","first-page":"61","article-title":"Cryptococcal infections in non-HIV-infected patients","volume":"124","author":"P G Pappas","year":"2013","journal-title":"Trans Am Clin Climatol Assoc"},{"issue":"05","key":"ref5","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1590\/S0037-86822008000500022","article-title":"[Guidelines in cryptococcosis\u20132008]","volume":"41","author":"M L Moretti","year":"2008","journal-title":"Rev Soc Bras Med Trop"},{"key":"ref6","volume-title":"Clinical manifestations and diagnosis of Cryptococcus neoformans meningoencephalitis in patients without HIV","author":"G M Cox","year":"2025"},{"issue":"03","key":"ref7","doi-asserted-by":"publisher","first-page":"e60431","DOI":"10.1371\/journal.pone.0060431","article-title":"Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status","volume":"8","author":"K D Brizendine","year":"2013","journal-title":"PLoS One"},{"issue":"07","key":"ref8","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/j.cmi.2024.03.031","article-title":"Features of cryptococcosis among 652 HIV-seronegative individuals in France: a cross-sectional observational study (2005\u20132020)","volume":"30","author":"O Paccoud","year":"2024","journal-title":"Clin Microbiol Infect"},{"issue":"08","key":"ref9","doi-asserted-by":"publisher","first-page":"e495","DOI":"10.1016\/S1473-3099(23)00731-4","article-title":"Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM","volume":"24","author":"C C Chang","year":"2024","journal-title":"Lancet Infect Dis"},{"issue":"03","key":"ref10","doi-asserted-by":"publisher","first-page":"omad016","DOI":"10.1093\/omcr\/omad016","article-title":"Neuro-cryptococcosis in an immunocompetent individual with radiologically atypical findings: a case report and review of literature","volume":"2023","author":"B U Regmi","year":"2023","journal-title":"Oxf Med Case Rep"},{"issue":"10","key":"ref11","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1086\/503570","article-title":"The poor prognosis of central nervous system cryptococcosis among nonimmunosuppressed patients: a call for better disease recognition and evaluation of adjuncts to antifungal therapy","volume":"42","author":"I Z Ecevit","year":"2006","journal-title":"Clin Infect Dis"},{"key":"ref12","volume-title":"Cryptococcus neoformans: treatment and prevention of meningoencephalitis and disseminated infection in patients without HIV","author":"G M Cox","year":"2025"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1827160.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:40:05Z","timestamp":1786660805000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1827160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":12,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["s00461827160"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1827160","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}