Cerebelitis criptococócica en paciente VIH negativo

Abstract

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.

Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique

“…With CNS involvement and meningitis, elevated intracranial pressure, defined as opening pressure of >20 cm H 2 O measured in a reclining position, is present in more than 50% of patients regardless of HIV status [9] and is generally associated with a high CSF yeast burden [10]. Clinical manifestation of cryptococcal meningitis includes fever, nausea, vomiting, and headache; there could also be signs of spinal root irritation in only one-third of patients, commonly the immunocompetent [11]. Other clinical variations exist when comparison is made between this meningitis in HIV and non-HIV infected patients, with the former having much less inflammatory response and shorter duration of symptoms but generally higher burden of organisms [9].…”

Cerebellar Cryptococcal Abscess in HIV-Negative Patient: A Case Report and Literature Review

“…Meanwhile, cerebellar infection is rare. Several cases of cerebellar cryptococcosis have been reported [6], [7], [8], [9], [10], [11], [12]. The clinical manifestations of cerebellar cryptococcosis is commonly present with signs of increased intracranial pressure and abnormality of cerebellar functions (ataxia and dysdiadochokinesis).…”

The Cerebellar Leptomeningeal Enhancement Associated with Cryptococcal Meningitis

“…Fluid attenuated inversion recovery imaging showed high-intensity areas at the cerebellar hemispheres and cerebellar swelling (Picture 4). Although leptomeningitis is a common cause of cases of non-AIDS-related cryptococcal meningitis (1), this is a rare case of cryptococcal meningitis with leptomeningeal enhancement limited to the cerebellum and no apparent cryptococcoma (2,3). Cryptococcus meningitis should be considered in patients with a high risk of inhaling cryptococcus antigen, even when the lesion is limited to the cerebellum and the patient has no pathological antecedents.…”