Cryptococcal cerebellitis in no-VIH patient
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Introduction: Cryptococcosis is an opportunistic fungal infection whose etiology is Cryptococcus neofromans / C. gattii, complex which affects immunocompromised patients mainly. Meningeal infection is one of the most common presentations, but cerebellar affection is rare.
Case Description: Male patient with 65 old years, from an area of subtropical climate with chronic exposure to poultry, without pathological antecedents, who presented clinical picture consistent with headache, fever, seizures and altered mental status.
Clinical findings and diagnostic methods: Initially without menigeal signs or intracranial hypertension and normal neurological examination. Later, the patient developed ataxia, dysdiadochokinesia and limb loss. By lumbar punction and image of nuclear magnetic resonance (NMR) cerebellitis cryptococcal was diagnosticated.
Treatment: Antifungal therapy with amphotericin B and fluconazole was performed, however the patient died.
Clinical Relevance: The cryptococcosis has different presentations, it´s a disease whose incidence has been increasing since the advent of the HIV / AIDS pandemy, however the commitment of the encephalic parenchyma and in particular the cerebellum is considered rare. In this way we are facing the first case of cryptococcal cerebellitis in our midst.
Zamora TO, Agredo DK, Agredo JS. Criptococosis Cerebral Análisis de 12 casos. Medicina (BOGOTA). 2013;35(101):104–122
Olszewski MA, Zhang Y, Huffnagle GB. Mechanisms of cryptococcal virulence and persistence. Future Microbiol. 2010;5(8):1269–1288
Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525–530
Sloan DJ, Parris V. Cryptococcal meningitis epidemiology and therapeutic options. Clini Epidemiol. 2014;6:169–182
Smith DK, Neal JJ, Holmberg SD. Unexplained opportunistic infections and CD4+ T-lymphocytopenia without HIV infection. N Engl J Med. 1993;328:373–379
Chen SC, Slavin MA, Heath CH, Playford EG, Byth K, Marriott D. Clinical manifestations of Criptococcus gattii infection determinants of Neurological Sequelae and Death. Clin Infect Dis. 2012;55(6):789–798
Bauer ME, Fuente Mde L. The role of oxidative and inflammatory stress and persistent viral infections in immunosenescence, Mech Ageing. Dev. 2016;158:27–37
Bauer ME, Fuente Mde L, Rahman I, Bagchi D. Inflammation, Advancing Age and Nutrition. Chapter 4 - Oxidative Stress, Inflammaging, and Immunosenescence2014. Academic Press: San Diego.
da Silva RE, Galvão MdeL, Takatani M, Ribeiro CD, Pivoto JGA, de Araújo TM. Cerebelite aguda por Cryptococcus em paciente imunocompetente relato de caso. Rev Bras Clin Med São Paulo. 2013;11(4):372
Sillero-Filho V, Souza ABM, Vaitsman RP, Morais RA, Coutinho PO, Lengruber R. Cerebellar cryptococcoma simulating metastatic neoplasm. Arq Neuro-Psiquiatr;. 2009;67(2a):290–292
Kaya S, Köksal I, Tosun I, Sari A, Alioglu Z. Cryptococcal meningitis with accompanying recurrent cerebellitis in an immunocompetent patient. Med Mycol Case Reports. 2012;1(1):127–129
Gologorsky Y, Delamora P, Souweidane MM, Greenfield JP. Cerebellar cryptococcoma in an immunocompetent child. J Neurosurg Pediat. 2007;107(4):314–317
Bi-Xia L, Xi-Jian D, Heng L, Hong-Han G, Yi-Xiang JW, Lun-Li Z. Cerebellar cryptococcosis characterized by a space-occupying lesion in an immunocompetent non-HIV patient. Neuropsychiat Dis Treat. 2015;11:21–24
Mukhopadhyay SL, Kumar M, Siddaiah N, Bahubali VKH, Bharath RD, Chickabasaviah YT, et al. Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India. JMM Case Reports. 2015;DOI: 10.1099/jmmcr.0.000052
Rai S, Jain S, Marak R, Dhole T. Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia. Indian J Medical Microbiol. 2012;30(3):367
Brizendine KD, Baddley JW, Pappas PG. Predictors of Mortality and Differences in Clinical Features among Patients with Cryptococcosis According to Immune Status. PLoS One. 2013;8(3):e60431
Lee Y-C, Wang J-T, Sun H-Y, Chen Y-C. Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection. J Microbiol Immunol Infect. 2011;44(5):338–345
Lizarazo J, Chaves Ó, Agudelo CI, Castañeda E. Comparación de los hallazgos clínicos y de supervivencia entre pacientes VIH positivos y VIH negativos con criptococosis meníngea en un hospital de tercer nivel. Acta Med Colomb. 2012;37(2):49–61
Saha DC, Xess I, Biswas A, Bhowmik DM, Padma MV. Detection of Cryptococcus by conventional, serological and molecular methods. J Medical Microbiol. 2009;58(8):1098–1105
Trilles L, Meyer W, Wanke B, Guarro J, Lazéra M. Correlation of antifungal susceptibility and molecular type within the Cryptococcus neoformans/C gattii species complex. Medical Mycol. 2012;50(3):328–332
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