A case of cryptococcal meningitis: Diagnosis by smears of albumin-glycerin dropped cerebrospinal fluid sediment

Background: Cryptococcal meningitis is frequently fatal without appropriate therapy, and may occur even in healthy persons. The organisms stain poorly in cerebrospinal fluid prepared for cytological examination and may be overlooked. We report a case of cryptococcal meningitis in a healthy person with emphasis on the cytological findings by a special preparation method. Case: A 51-year-old healthy woman had complained of headache and fever for two months. Sudden deterioration in mental status and nuchal stiffness prompted a lumbar punc ture. The background of the cytology specimen was relatively clear with a few lymphocytes. Numerous yeast-like organisms, 5 to 15 μm in diameter, were observed. Most of them were poorly stained in Papanicolaou stain, but a few were slightly greenish and showed thin-necked buds and thick capsules. With PAS stain, they appeared red-purple, and with Giemsa, deep purple. In Papanicolaou-stained smears of the albumin-glycerin dropped sediment, perifungal halos were conspicuous and the organisms were easily identified.Cryptococcous neoformans was cultured, and cryptococcal meningitis was diagnosed. Conclusion: Papanicolaou-stained smears of albuminglycerin dropped cerebrospinal fluid sediment are very useful in the laboratory diagnosis of cryptococcal meningitis.