{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:13:05Z","timestamp":1783620785200,"version":"3.55.0"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2026,6,27]]},"abstract":"<jats:p>\n                    In HIV-negative cryptococcal meningoencephalitis, neurological deterioration can occur despite sterile follow-up cerebrospinal fluid (CSF) cultures, often due to postinfectious inflammatory response syndrome (PIIRS). A 37-year-old man presented with progressive headache, subacute ataxia, dysarthria and confusion. An MR scan of brain showed cerebellar-predominant T2\/fluid-attenuated inversion recovery hyperintensities, leptomeningeal enhancement and acute microinfarcts. CSF showed elevated opening pressure, neutrophilic pleocytosis, low glucose and high protein. After confirming\n                    <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                    , we started liposomal amphotericin B and flucytosine. Despite early improvement, he deteriorated around day 35 with sustained intracranial hypertension and progressive inflammation on imaging, yet with sterile follow-up cultures. We suspected PIIRS and gave intravenous methylprednisolone. He improved rapidly, with normalisation of CSF and intracranial pressure. Paradoxical worsening requires structured reassessment; confirming microbiological control allows targeted immunomodulation to reverse inflammatory injury.\n                  <\/jats:p>","DOI":"10.1136\/pn-2026-005249","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:20:23Z","timestamp":1783617623000},"page":"pn-2026-005249","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebellar-predominant cryptococcal meningoencephalitis complicated by postinfectious inflammatory response syndrome in an apparently immunocompetent host"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7014-3128","authenticated-orcid":false,"given":"Carlos","family":"Alvarado-De la Hoz","sequence":"first","affiliation":[{"name":"Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogot\u00e1, Colombia"},{"name":"University Hospital San Ignacio, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia A","family":"Andrade-Rond\u00f3n","sequence":"additional","affiliation":[{"name":"Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogot\u00e1, Colombia"},{"name":"University Hospital San Ignacio, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9528-914X","authenticated-orcid":false,"given":"Jos\u00e9 Andr\u00e9s","family":"Ordo\u00f1ez Gutierrez","sequence":"additional","affiliation":[{"name":"Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogot\u00e1, Colombia"},{"name":"University Hospital San Ignacio, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s F","family":"C\u00e1rdenas-Cruz","sequence":"additional","affiliation":[{"name":"University Hospital San Ignacio, Bogot\u00e1, Colombia"},{"name":"Neurology, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta L","family":"Ramos","sequence":"additional","affiliation":[{"name":"University Hospital San Ignacio, Bogot\u00e1, Colombia"},{"name":"Neurology, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e1n Alejandro","family":"Mackenzie-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia"},{"name":"Infectious Diseases, University Hospital San Ignacio, Bogot\u00e1, 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