Fundación Valle del Lili, Department of Internal Medicine, Cra. 98 No. 18-49, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia.
Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia; Fundación Valle del Lili, Department of Neurology, Cra. 98 No. 18-49, Cali, Colombia.
J Infect Public Health. 2020 Jan;13(1):143-148. doi: 10.1016/j.jiph.2019.06.005. Epub 2019 Jul 24.
Cryptococcus is a cosmopolitan fungus with tropism for the nervous system and a higher prevalence of infection in immunosuppressed patients. Neurological compromise caused by this microorganism mainly debuts as a meningeal syndrome (headache, fever, neck stiffness) with predominant encephalic involvement. In this report we present the rare case of a non-HIV patient with flaccid paralysis and peripheral nerve involvement due to crytpococcal meningitis. This is a 53-years-old woman, with a past-medical history of diabetes, who presented with dysarthria, unilateral peripheral facial paralysis, asymmetric ascending quadriparesis, generalized hyporeflexia and urinary retention. Neuroimaging was initially reported as negative for vascular or demyelinating diseases. Electrophysiological studies were performed, and acute flaccid paralysis of undetermined etiology was defined as a temporal clinical diagnosis. Cerebrospinal fluid molecular analysis confirmed the presence of Cryptococcus neoformans var. gatti; posteriorly, antifungal treatment with amphotericin B and fluconazole was started. Polyneuroradiculopathy symptoms significantly improved over the in-hospital stay. In conclusion, spinal cord and peripheral nerve involvement by Cryptococcus is an infrequent cause of acute flaccid paralysis that should be considered in the differential diagnosis even in HIV-negative patients.
隐球菌是一种具有嗜神经性且在免疫抑制患者中感染更为普遍的世界性真菌。该微生物引起的神经损伤主要表现为脑膜综合征（头痛、发热、颈部僵硬），伴有明显的脑部受累。在本报告中，我们介绍了一例罕见的非 HIV 患者，因隐球菌性脑膜炎导致弛缓性瘫痪和周围神经受累。这是一位 53 岁女性，既往有糖尿病病史，表现为构音障碍、单侧周围性面瘫、不对称性上升性四肢瘫痪、全身腱反射减弱和尿潴留。神经影像学最初报告为血管或脱髓鞘疾病阴性。进行了电生理学研究，并将原因不明的急性弛缓性瘫痪定义为临时临床诊断。脑脊液分子分析证实存在新型隐球菌 var. gatti；随后，开始使用两性霉素 B 和氟康唑进行抗真菌治疗。住院期间，多神经根神经病症状显著改善。总之，脊髓和周围神经受累是隐球菌引起急性弛缓性瘫痪的罕见原因，即使在 HIV 阴性患者中，也应考虑将其纳入鉴别诊断。
