{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:17:44Z","timestamp":1778084264996,"version":"3.51.4"},"reference-count":74,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                    causes serious infections of the central nervous system, including meningitis, encephalitis, or cryptococcomas, and is increasingly reported in immunocompetent individuals. Cryptococcal choroid plexitis is a rare entity that often presents with ependymitis and synechiae formation, resulting in \u201ctrapped ventricles.\u201d Cryptococcomas forming gelatinous pseudocysts manifest as prominent Virchow-Robin spaces and lead to false-negative smear and culture reports, leading to a delay in diagnosis. We report a 37-year-old woman from Assam with chronic headache for 3 months, recurrent seizures, and altered mentation for 15 days. Contrast-enhanced magnetic resonance imaging showed features of choroid plexitis and obstructive hydrocephalus with \u201ctrapped\u201d temporal horns of the ventricle. Serum and cerebrospinal fluid cryptococcal antigen were weakly positive, with negative fungal smear and cultures. She was treated with liposomal amphotericin B with flucytosine but developed brainstem herniation and died. Autopsy of the brain revealed bulky choroid plexus with prominent Virchow-Robin spaces and gelatinous pseudocysts. Microscopic examination revealed multiple periventricular microabscesses teeming with cryptococcal organisms. The case, along with a systematic review of similar cases in the literature, highlights the complexities in diagnosing and managing cryptococcal meningoencephalitis in the immunocompetent host.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0614","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:01:31Z","timestamp":1774969291000},"page":"975-980","source":"Crossref","is-referenced-by-count":0,"title":["Cryptococcal Choroid Plexitis with Trapped Ventricle in an Immunocompetent Individual: An Autopsy Case with Systematic Review of Reported Cases"],"prefix":"10.4269","volume":"114","author":[{"given":"Angel","family":"Miraclin T","sequence":"first","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sathyakumar","family":"Rima","sequence":"additional","affiliation":[{"name":"Department of General Pathology, Division of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harshad Arvind","family":"Vanjare","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Davis","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gomathy","family":"Krithiga","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaikh Atif Iqbal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Appaswamy Thirumal","family":"Prabhakar","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geeta","family":"Chacko","sequence":"additional","affiliation":[{"name":"Department of General Pathology, Division of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Antony Jude","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Rupali","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjith","family":"Aaron","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajith","family":"Sivadasan","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Nat Rev Dis Primers","first-page":"62","article-title":"Cryptococcal meningitis","volume":"9","author":"Tugume","year":"2023"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"611","article-title":"Cryptococcal disease of the CNS in immunocompetent hosts: Influence of cryptococcal variety on clinical manifestations and outcome","volume":"20","author":"Mitchell","year":"1995"},{"key":"b3","series-title":"J Fungi (Basel)","first-page":"586","article-title":"Mechanisms and Virulence Factors of Cryptococcus neoformans Dissemination to the Central Nervous System","volume":"10","author":"Al-Huthaifi","year":"2024"},{"key":"b4","series-title":"Indian J Med Microbiol","first-page":"25","article-title":"Changing paradigm of cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India","volume":"33","author":"Abhilash","year":"2015"},{"key":"b5","series-title":"Open Forum Infect Dis","first-page":"ofad420","article-title":"Cryptococcal meningitis in young, immunocompetent patients: A single-center retrospective case series and review of the literature","volume":"10","author":"Stack","year":"2023"},{"key":"b6","series-title":"QJM","first-page":"143","article-title":"Cryptococcosis in apparently immunocompetent patients","volume":"99","author":"Lui","year":"2006"},{"key":"b7","series-title":"Sci Rep","first-page":"9184","article-title":"Choroid plexitis and ependymitis by magnetic resonance imaging are biomarkers of neuronal damage and inflammation in HIV-negative cryptococcal meningoencephalitis","volume":"7","author":"Hammoud","year":"2017"},{"key":"b8","series-title":"J Neurol Sci","first-page":"180","article-title":"Atypical clinical and radiological presentation of cryptococcal choroid plexitis in an immunocompetent woman","volume":"334","author":"Dubbioso","year":"2013"},{"key":"b9","series-title":"Cureus","first-page":"e65544","article-title":"Choroid plexitis and obstructive hydrocephalus secondary to cryptococcal meningoencephalitis in an immunocompetent individual with remarkable imaging findings: A case report","volume":"16","author":"Santana Veliz","year":"2024"},{"key":"b10","series-title":"Clin Infect Dis","first-page":"1443","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":"Ecevit","year":"2006"},{"key":"b11","series-title":"Sci Rep","first-page":"7493","article-title":"Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: An autopsy study","volume":"9","author":"Hurtado","year":"2019"},{"key":"b12","series-title":"Br J Radiol","first-page":"e014","article-title":"Cryptococcal choroid plexitis: Rare imaging findings of central nervous system cryptococcal infection in an immunocompetent individual","volume":"83","author":"Kumari","year":"2010"},{"key":"b13","series-title":"Hum Pathol","first-page":"839","article-title":"Pathology of cryptococcal meningoencephalitis: Analysis of 27 patients with pathogenetic implications","volume":"27","author":"Lee","year":"1996"},{"key":"b14","series-title":"IDCases","first-page":"e00699","article-title":"Immune reconstitution inflammatory syndrome following Cryptococcal neoformans infection in an immunocompetent host: A case report and review of the literature","volume":"19","author":"Kathiresu","year":"2020"},{"key":"b15","series-title":"J Neurosurg","first-page":"145","article-title":"Intraventricular cryptococcal granuloma. Report of two cases","volume":"68","author":"Penar","year":"1988"},{"key":"b16","series-title":"Surg Neurol","first-page":"253","article-title":"Septation and focal dilatation of ventricles associated with cryptococcal meningoencephalitis","volume":"25","author":"Ofori-Kwakye","year":"1986"},{"key":"b17","series-title":"AJNR Am J Neuroradiol","first-page":"273","article-title":"Cryptococcal choroid plexitis as a mass lesion: MR imaging and histopathologic correlation","volume":"23","author":"Kovoor","year":"2002"},{"key":"b18","series-title":"Cureus","first-page":"e8512","article-title":"Cryptococcal choroid plexitis and non-communicating hydrocephalus","volume":"12","author":"O\u2019Connor","year":"2020"},{"key":"b19","series-title":"Intern Med","first-page":"1775","article-title":"Cryptococcal choroid plexitis and ependymitis in progressive dementia","volume":"64","author":"Okajima","year":"2025"},{"key":"b20","series-title":"Can J Neurol Sci","first-page":"117","article-title":"Cryptococcal choroid plexitis an uncommon fungal disease. Case report and review","volume":"36","author":"C\u00e1rdenas Hern\u00e1ndez","year":"2009"},{"key":"b21","series-title":"Neuroradiology","first-page":"303","article-title":"MRI features of choroid plexitis","volume":"40","author":"Cho","year":"1998"},{"key":"b22","series-title":"N Engl J Med","first-page":"1597","article-title":"Cryptococcal disease in diverse hosts","volume":"390","author":"Meya","year":"2024"},{"key":"b23","series-title":"Crit Rev Microbiol","first-page":"1","article-title":"Environmental prevalence of Cryptococcus neoformans and Cryptococcus gattii in India: An update","volume":"38","author":"Chowdhary","year":"2012"},{"key":"b24","series-title":"PLoS One","first-page":"e0265739","article-title":"The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia","volume":"17","author":"Sim","year":"2022"},{"key":"b25","series-title":"Ann Indian Acad Neurol","first-page":"322","article-title":"Cryptococcal postinfectious inflammatory response syndrome in an immunocompetent host","volume":"22","author":"Kulkarni","year":"2019"},{"key":"b26","series-title":"J Microbiol Immunol Infect","first-page":"296","article-title":"Different presentations and outcomes between HIV-infected and HIV-uninfected patients with Cryptococcal meningitis","volume":"45","author":"Liao","year":"2012"},{"key":"b27","series-title":"Case Rep Neurol","first-page":"204","article-title":"Refractory Cryptococcus neoformans meningoencephalitis in an immunocompetent patient: Paradoxical antifungal therapy-induced clinical deterioration related to an immune response to cryptococcal organisms","volume":"7","author":"Nakajima","year":"2015"},{"key":"b28","series-title":"J Investig Med High Impact Case Rep","first-page":"2324709619834578","article-title":"Cryptococcal meningitis in an apparent immunocompetent patient","volume":"7","author":"Poley","year":"2019"},{"key":"b29","series-title":"BMC Infect Dis","first-page":"51","article-title":"Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: A retrospective study","volume":"17","author":"Qu","year":"2017"},{"key":"b30","series-title":"J Clin Neurosci","first-page":"57","article-title":"The prognostic factors of HIV-negative adult cryptococcal meningitis with a focus on cranial MRI-based neuroimaging findings","volume":"55","author":"Tsai","year":"2018"},{"key":"b31","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1367","article-title":"Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis","volume":"36","author":"Zhong","year":"2017"},{"key":"b32","series-title":"J Clin Microbiol","first-page":"e01238-18","article-title":"Cryptococcal meningitis diagnostics and screening in the era of point-of-care laboratory testing","volume":"57","author":"Rajasingham","year":"2019"},{"key":"b33","series-title":"BMC Infect Dis","first-page":"217","article-title":"Disseminated cryptococcosis with gastrointestinal involvement and false-negative cryptococcal antigen testing due to postzone phenomenon: A case report and review of the literature","volume":"23","author":"Zimmet","year":"2023"},{"key":"b34","series-title":"N Engl J Med","first-page":"542","article-title":"Adjunctive dexamethasone in HIV-associated cryptococcal meningitis","volume":"374","author":"Beardsley","year":"2016"},{"key":"b35","series-title":"N Engl J Med","first-page":"188","article-title":"Dexamethasone in cryptococcal meningitis","volume":"375","author":"Panackal","year":"2016"},{"key":"b36","article-title":"Guidelines for Diagnosing, Preventing and Managing Cryptococcal Disease among Adults, Adolescents and Children Living with HIV.","year":"2022"},{"key":"b37","series-title":"Environ Microbiol Rep","first-page":"375","article-title":"Global warming impact on the expansion of fundamental niche of Cryptococcus gattii VGI in Europe","volume":"13","author":"Cogliati","year":"2021"},{"key":"b1","series-title":"Nat Rev Dis Primers","first-page":"62","article-title":"Cryptococcal meningitis","volume":"9","author":"Tugume","year":"2023"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"611","article-title":"Cryptococcal disease of the CNS in immunocompetent hosts: Influence of cryptococcal variety on clinical manifestations and outcome","volume":"20","author":"Mitchell","year":"1995"},{"key":"b3","series-title":"J Fungi (Basel)","first-page":"586","article-title":"Mechanisms and Virulence Factors of Cryptococcus neoformans Dissemination to the Central Nervous System","volume":"10","author":"Al-Huthaifi","year":"2024"},{"key":"b4","series-title":"Indian J Med Microbiol","first-page":"25","article-title":"Changing paradigm of cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India","volume":"33","author":"Abhilash","year":"2015"},{"key":"b5","series-title":"Open Forum Infect Dis","first-page":"ofad420","article-title":"Cryptococcal meningitis in young, immunocompetent patients: A single-center retrospective case series and review of the literature","volume":"10","author":"Stack","year":"2023"},{"key":"b6","series-title":"QJM","first-page":"143","article-title":"Cryptococcosis in apparently immunocompetent patients","volume":"99","author":"Lui","year":"2006"},{"key":"b7","series-title":"Sci Rep","first-page":"9184","article-title":"Choroid plexitis and ependymitis by magnetic resonance imaging are biomarkers of neuronal damage and inflammation in HIV-negative cryptococcal meningoencephalitis","volume":"7","author":"Hammoud","year":"2017"},{"key":"b8","series-title":"J Neurol Sci","first-page":"180","article-title":"Atypical clinical and radiological presentation of cryptococcal choroid plexitis in an immunocompetent woman","volume":"334","author":"Dubbioso","year":"2013"},{"key":"b9","series-title":"Cureus","first-page":"e65544","article-title":"Choroid plexitis and obstructive hydrocephalus secondary to cryptococcal meningoencephalitis in an immunocompetent individual with remarkable imaging findings: A case report","volume":"16","author":"Santana Veliz","year":"2024"},{"key":"b10","series-title":"Clin Infect Dis","first-page":"1443","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":"Ecevit","year":"2006"},{"key":"b11","series-title":"Sci Rep","first-page":"7493","article-title":"Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: An autopsy study","volume":"9","author":"Hurtado","year":"2019"},{"key":"b12","series-title":"Br J Radiol","first-page":"e014","article-title":"Cryptococcal choroid plexitis: Rare imaging findings of central nervous system cryptococcal infection in an immunocompetent individual","volume":"83","author":"Kumari","year":"2010"},{"key":"b13","series-title":"Hum Pathol","first-page":"839","article-title":"Pathology of cryptococcal meningoencephalitis: Analysis of 27 patients with pathogenetic implications","volume":"27","author":"Lee","year":"1996"},{"key":"b14","series-title":"IDCases","first-page":"e00699","article-title":"Immune reconstitution inflammatory syndrome following Cryptococcal neoformans infection in an immunocompetent host: A case report and review of the literature","volume":"19","author":"Kathiresu","year":"2020"},{"key":"b15","series-title":"J Neurosurg","first-page":"145","article-title":"Intraventricular cryptococcal granuloma. Report of two cases","volume":"68","author":"Penar","year":"1988"},{"key":"b16","series-title":"Surg Neurol","first-page":"253","article-title":"Septation and focal dilatation of ventricles associated with cryptococcal meningoencephalitis","volume":"25","author":"Ofori-Kwakye","year":"1986"},{"key":"b17","series-title":"AJNR Am J Neuroradiol","first-page":"273","article-title":"Cryptococcal choroid plexitis as a mass lesion: MR imaging and histopathologic correlation","volume":"23","author":"Kovoor","year":"2002"},{"key":"b18","series-title":"Cureus","first-page":"e8512","article-title":"Cryptococcal choroid plexitis and non-communicating hydrocephalus","volume":"12","author":"O\u2019Connor","year":"2020"},{"key":"b19","series-title":"Intern Med","first-page":"1775","article-title":"Cryptococcal choroid plexitis and ependymitis in progressive dementia","volume":"64","author":"Okajima","year":"2025"},{"key":"b20","series-title":"Can J Neurol Sci","first-page":"117","article-title":"Cryptococcal choroid plexitis an uncommon fungal disease. Case report and review","volume":"36","author":"C\u00e1rdenas Hern\u00e1ndez","year":"2009"},{"key":"b21","series-title":"Neuroradiology","first-page":"303","article-title":"MRI features of choroid plexitis","volume":"40","author":"Cho","year":"1998"},{"key":"b22","series-title":"N Engl J Med","first-page":"1597","article-title":"Cryptococcal disease in diverse hosts","volume":"390","author":"Meya","year":"2024"},{"key":"b23","series-title":"Crit Rev Microbiol","first-page":"1","article-title":"Environmental prevalence of Cryptococcus neoformans and Cryptococcus gattii in India: An update","volume":"38","author":"Chowdhary","year":"2012"},{"key":"b24","series-title":"PLoS One","first-page":"e0265739","article-title":"The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia","volume":"17","author":"Sim","year":"2022"},{"key":"b25","series-title":"Ann Indian Acad Neurol","first-page":"322","article-title":"Cryptococcal postinfectious inflammatory response syndrome in an immunocompetent host","volume":"22","author":"Kulkarni","year":"2019"},{"key":"b26","series-title":"J Microbiol Immunol Infect","first-page":"296","article-title":"Different presentations and outcomes between HIV-infected and HIV-uninfected patients with Cryptococcal meningitis","volume":"45","author":"Liao","year":"2012"},{"key":"b27","series-title":"Case Rep Neurol","first-page":"204","article-title":"Refractory Cryptococcus neoformans meningoencephalitis in an immunocompetent patient: Paradoxical antifungal therapy-induced clinical deterioration related to an immune response to cryptococcal organisms","volume":"7","author":"Nakajima","year":"2015"},{"key":"b28","series-title":"J Investig Med High Impact Case Rep","first-page":"2324709619834578","article-title":"Cryptococcal meningitis in an apparent immunocompetent patient","volume":"7","author":"Poley","year":"2019"},{"key":"b29","series-title":"BMC Infect Dis","first-page":"51","article-title":"Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: A retrospective study","volume":"17","author":"Qu","year":"2017"},{"key":"b30","series-title":"J Clin Neurosci","first-page":"57","article-title":"The prognostic factors of HIV-negative adult cryptococcal meningitis with a focus on cranial MRI-based neuroimaging findings","volume":"55","author":"Tsai","year":"2018"},{"key":"b31","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1367","article-title":"Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis","volume":"36","author":"Zhong","year":"2017"},{"key":"b32","series-title":"J Clin Microbiol","first-page":"e01238-18","article-title":"Cryptococcal meningitis diagnostics and screening in the era of point-of-care laboratory 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