Abbas Hafsa, CiFuentes Kottkamp Angelica, Abbas Naeem, Cindrich Richard, Singh Manisha
Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
Department of Medicine, Division of Infectious Diseases and Immunology, New York University School of Medicine, New York, NY, USA.
Am J Case Rep. 2018 Feb 19;19:183-186. doi: 10.12659/ajcr.906869.
BACKGROUND Cryptococcal meningitis in patients who are seronegative for the human immunodeficiency virus (HIV) and in patients who are splenectomized is rare. This report is an unusual case of meningeal and cerebellar infection due to the encapsulated yeast, Cryptococcus neoformans, which has not previously been associated with asplenia. CASE REPORT A 65-year-old HIV-negative patient with a previous splenectomy, presented with a three-day history of fever, vomiting, and headache. His symptoms progressed to generalized body aches, persistent fever, and neck stiffness. A lumbar puncture was performed, and cerebrospinal fluid (CSF) culture grew Cryptococcus neoformans. Treatment commenced with intravenous amphotericin B and flucytosine. The patient required serial lumbar punctures due to persistent raised intracranial pressure (ICP). Magnetic resonance imaging (MRI) of the brain showed acute meningitis and cerebellitis. Antimicrobial therapy and CSF drainage resulted in clinical improvement. CONCLUSIONS The occurrence of meningeal and cerebellar cryptococcosis in an asplenic patient is rare, and few cases have been previously reported. This case report highlights the possibility of invasive cryptococcal infection, or cryptococcosis, in asplenic individuals in the absence of HIV infection.
人类免疫缺陷病毒（HIV）血清学阴性患者及脾切除患者发生隐球菌性脑膜炎较为罕见。本报告是一例由新型隐球菌这种包膜酵母菌引起的脑膜和小脑感染的罕见病例，此前未曾发现其与无脾症有关。病例报告：一名65岁既往有脾切除术史的HIV阴性患者，出现发热、呕吐和头痛3天。其症状进展为全身酸痛、持续发热和颈部僵硬。进行了腰椎穿刺，脑脊液（CSF）培养出新型隐球菌。开始静脉注射两性霉素B和氟胞嘧啶进行治疗。由于颅内压（ICP）持续升高，患者需要多次腰椎穿刺。脑部磁共振成像（MRI）显示急性脑膜炎和小脑炎。抗菌治疗和脑脊液引流使临床症状得到改善。结论：无脾患者发生脑膜和小脑隐球菌病很罕见，此前鲜有病例报道。本病例报告强调了在无HIV感染的无脾个体中发生侵袭性隐球菌感染即隐球菌病的可能性。
