Cryptic clues: Hemichorea, hypersomnolence, and bilateral thalamic pulvinar calcification in cryptococcal meningoencephalitis

Abstract

Cryptococcal meningoencephalitis (CME) is a severe fungal infection which although common, is challenging to identify in its early stages particularly in resource limited settings. This case report aims to enhance clinicians’ ability to recognise atypical signs of CME, facilitating early diagnosis and treatment. We report here a 63-year-old male with an atypical presentation of CME including subacute hemichorea which eventually became generalised; hypersomnolence, and bilateral pulvinar calcifications. Initial misinterpretation of these findings led to a delay in diagnosis. Despite receiving appropriate treatment, the patient ultimately succumbed to the infection. In conclusion, this case highlights the diagnostic challenges in CME, particularly in patients without classical symptoms like fever or headache. Additionally, it also highlights the potential link between pulvinar calcifications and CME, emphasising the need for further investigation into the potential role of this sign as a diagnostic clue.