Rural Clinical School, University of New South Wales.
Rural Clinical School, University of Notre Dame.
Neurologist. 2020 Dec 30;26(1):24-26. doi: 10.1097/NRL.0000000000000297.
Cryptococcus, a yeast-like fungus, is the most common cause of fungal meningitis worldwide. The Cryptococcus gattii variety is concentrated in Australia has a greater propensity to infect immunocompetent hosts, cause meningitis and form crytococcomas. This case presents a novel disease complication, that is, acute neurological symptoms without seizures, disease progression or reactivation.
A 58-year-old immunocompetent male was brought to the emergency department with dysarthria and right arm paraesthesias. Computed tomography of the brain brain and magnetic resonance imaging revealed no stroke but found several previously identified crytococcomas that demonstrated no interval change. Blood tests and lumbar puncture found only a low cryptococcal antigen complex titer (CRAG) (1:10) and a negative cell culture. He had remained compliant on his maintenance fluconazole therapy and had no immunocompromise or seizure activity. He was initially treated as a relapse of cryptococcal disease and restarted on induction therapy but after the cell culture returned negative and the symptoms resolved over the following days he was reverted back to maintenance therapy.
Central nervous system cryptococcomas are difficult to treat, chronic infections, that in our patient had lasted over 10 years despite treatment compliance. A true cryptococcal meningitis relapse is indicated by positive cell cultures in previously sterile fluid but cryptococcoma progression is measured by serial magnetic resonance imaging or computed tomography scans. In the case of progression or relapse induction and consolidation therapy should be restarted. Our patient demonstrated neither relapse nor progression but presented with a novel disease complication of acute fluctuating neurology in chronic stable cryptococcomas.
cryptococcus 是一种酵母样真菌，是世界范围内最常见的真菌性脑膜炎病原体。 cryptococcus gattii 变种集中在澳大利亚，更倾向于感染免疫功能正常的宿主，引起脑膜炎和 cryptococcomas。本病例提出了一种新的疾病并发症，即无癫痫、疾病进展或再激活的急性神经症状。
一名 58 岁免疫功能正常的男性因构音障碍和右臂感觉异常被送往急诊室。脑部计算机断层扫描和磁共振成像显示无中风，但发现了几个先前确定的 cryptococcomas，这些 cryptococcomas 没有间隔变化。血液检查和腰椎穿刺仅发现低 cryptococcal 抗原复合物滴度（CRAG）（1:10）和阴性细胞培养。他一直坚持服用氟康唑维持治疗，没有免疫抑制或癫痫活动。他最初被诊断为 cryptococcal 病复发，并重新开始诱导治疗，但在细胞培养物转为阴性且症状在接下来的几天内缓解后，他又恢复了维持治疗。
中枢神经系统 cryptococcomas 是难以治疗的慢性感染，在我们的患者中，尽管治疗依从性良好，但持续了 10 多年。真正的 cryptococcal 脑膜炎复发的标志是先前无菌液体中的阳性细胞培养，但 cryptococcoma 的进展是通过连续的磁共振成像或计算机断层扫描来测量的。在进展或复发的情况下，应重新开始诱导和巩固治疗。我们的患者既没有复发也没有进展，但表现出慢性稳定 cryptococcomas 中急性波动性神经的新疾病并发症。
