To report clinical data, CSF profiles, imaging findings, treatments, and outcomes in a two-center case series of cerebral cryptococcosis from Bogotá, Colombia.

Cerebral cryptococcosis is the leading opportunistic CNS mycosis. Data from Latin America on the clinical spectrum, MRI patterns, and treatment remain limited.

We reviewed the medical records of patients with CNS cryptococcosis confirmed by CSF cryptococcal antigen and/or culture who were treated at Hospital of San José and Hospital Infantil Universitario de San José in Bogotá, Colombia during 2023-2024. Statistical analysis was performed using IBM SPSS. Quantitative variables were described with proportions (percentages), and continuous data were summarized with medians and interquartile ranges.

Twelve patients with cryptococcal meningitis were included. Ten patients (83.3%) were male, with a median age of 52 years (IQR 35-68). Headache was the most common symptom (n=11), followed by neuropsychiatric disorder (n=7), nausea/vomiting (n=6), and seizures (n=6). Four patients were HIV-positive. CSF results showed a mean protein concentration of 231.85 mg/dl, 184.83 leukocytes/μL, and glucose of 32.41 mg/dl.

MRI was performed in nine patients, with five (41.7%) showing leptomeningeal enhancement. Six patients (50%) had abnormal VEEG, mainly due to encephalopathy (41.7%). The most common initial treatment was Amphotericin B deoxycholate (41.7%), but eight patients developed acute renal failure, leading to treatment modification. Four patients (33.3%) died during hospitalization.

This series highlights that cerebral cryptococcosis in Bogotá affects both immunosuppressed and immunocompetent individuals and frequently presents with headache and signs of intracranial hypertension. Toxicity related to Amphotericin B deoxycholate was a major reason for treatment changes. These findings underscore the importance of early diagnosis, improved access to safer antifungal therapies, and closer monitoring of CSF dynamics in real-world settings.