{
  "abstract": "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 Cryptococcus neoformans, 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.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogotá, Colombia",
        "University Hospital San Ignacio, Bogotá, Colombia"
      ],
      "name": "Carlos Alvarado-De la Hoz"
    },
    {
      "affiliations": [
        "Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogotá, Colombia",
        "University Hospital San Ignacio, Bogotá, Colombia"
      ],
      "name": "Silvia A Andrade-Rondón"
    },
    {
      "affiliations": [
        "Neurology, Pontificia Universidad Javeriana Facultad de Medicina, Bogotá, Colombia",
        "University Hospital San Ignacio, Bogotá, Colombia"
      ],
      "name": "José Andrés Ordoñez Gutierrez"
    },
    {
      "affiliations": [
        "University Hospital San Ignacio, Bogotá, Colombia",
        "Neurology, Pontificia Universidad Javeriana, Bogotá, Colombia"
      ],
      "name": "Andrés F Cárdenas-Cruz"
    },
    {
      "affiliations": [
        "University Hospital San Ignacio, Bogotá, Colombia",
        "Neurology, Pontificia Universidad Javeriana, Bogotá, Colombia"
      ],
      "name": "Marta L Ramos"
    },
    {
      "affiliations": [
        "Infectious Diseases, Pontificia Universidad Javeriana, Bogotá, Colombia",
        "Infectious Diseases, University Hospital San Ignacio, Bogotá, Colombia"
      ],
      "name": "Sebastián Alejandro Mackenzie-Martínez"
    }
  ],
  "title": "Cerebellar-predominant cryptococcal meningoencephalitis complicated by postinfectious inflammatory response syndrome in an apparently immunocompetent host",
  "uid": "a860e626-2491-588f-8067-237f08baa5cb"
}