Nucci A, Maciel Júnior J A, Queiroz L de S, Montenegro M A, De Carvalho R B
Department of Neurology, State University of Campinas, Medical School, SP-Brasil.
Arq Neuropsiquiatr. 1999 Sep;57(3A):678-82. doi: 10.1590/s0004-282x1999000400023.
We report a case of neurocryptococcosis which is unique in the literature because the patient had a pseudocystic form of the disease during pregnancy and without any evidence of AIDS. The clinical picture was that of intracranial hypertension and the epidemiological background was highly suggestive of cysticercosis. CT showed multiple round hypodense lesions in the basal ganglia and cerebellum, without contrast enhancement. Since a scolex was not visible, the diagnosis of neurocysticercosis was considered probable. CSF examination was not performed in view of its high risk. The patient had progressive downhill course. Autopsy disclosed multiple gelatinous pseudocysts in the cerebral and cerebellar gray matter, containing abundant Cryptococcus neoformans. Meningeal involvement was minimal. The child was delivered by caesarean section and was free of infection, but died later of hyaline membrane disease. The neuroimaging appearances of this rare instance of the pseudocystic form of neurocryptococcosis mimicked closely neurocysticercosis and only postmortem examination allowed correct diagnosis. The pseudocystic form has so far only been reported in AIDS.
我们报告一例神经隐球菌病病例，该病例在文献中较为独特，因为患者在孕期患有一种假性囊肿型疾病，且无任何艾滋病证据。临床表现为颅内高压，流行病学背景高度提示囊尾蚴病。CT显示基底节和小脑有多个圆形低密度病变，无强化。由于未见头节，神经囊尾蚴病的诊断可能性较大。鉴于风险较高，未进行脑脊液检查。患者病情呈进行性恶化。尸检发现大脑和小脑灰质中有多个胶冻状假性囊肿，内含大量新型隐球菌。脑膜受累轻微。患儿通过剖宫产娩出，未受感染，但后来死于透明膜病。这种罕见的假性囊肿型神经隐球菌病的神经影像学表现与神经囊尾蚴病极为相似，仅尸检才得以正确诊断。迄今为止，假性囊肿型仅在艾滋病患者中报道过。
