Seetahal-Maraj Panduranga, Giddings Stanley, Ramcharan Kanterpersad, Ramnarine Narindra
Neurosurgery, San Fernando General Hospital, San Fernando, TTO.
Faculty of Clinical Medical Sciences, The University of the West Indies, Trinidad, TTO.
Cureus. 2021 Oct 22;13(10):e18975. doi: 10.7759/cureus.18975. eCollection 2021 Oct.
Cryptococcal infections of the central nervous system (CNS) are common opportunistic infections in immunocompromised hosts. They can occur in immunocompetent hosts, and this has been documented in isolated case reports. Rapid neurological deterioration can be seen, particularly with hydrocephalus, and diagnosis can be difficult without a high index of suspicion. Treatment arms include prolonged antifungal therapy and cerebrospinal fluid (CSF) diversion procedures. We present a case of a middle-aged immunocompetent male, who presented with an acute confusional state and papilledema. An urgent computed tomography (CT) and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus, and an external ventricular drain was placed. CSF samples were collected, and analysis revealed cryptococcal infection. He was treated with antifungal therapy but failed external ventricular drain challenging. A ventriculoperitoneal shunt was placed after negative CSF studies were obtained. While uncommon, cryptococcal meningitis in immunocompetent hosts can present with obstructive hydrocephalus. It can result in rapid neurological decline and death. Emergent CSF diversion and antifungal therapy are the primary treatment modalities. CSF diversion may be permanently required in some cases.
中枢神经系统（CNS）隐球菌感染是免疫功能低下宿主常见的机会性感染。它们也可发生在免疫功能正常的宿主中，这在个别病例报告中已有记载。尤其是伴有脑积水时，可出现快速的神经功能恶化，若没有高度的怀疑指数，诊断可能会很困难。治疗方法包括长期抗真菌治疗和脑脊液（CSF）分流手术。我们报告一例中年免疫功能正常男性病例，该患者表现为急性意识模糊状态和视乳头水肿。紧急计算机断层扫描（CT）和磁共振成像（MRI）显示梗阻性脑积水，并放置了外部脑室引流管。采集了脑脊液样本，分析显示为隐球菌感染。给予抗真菌治疗，但外部脑室引流管试验失败。在脑脊液检查结果为阴性后，放置了脑室腹腔分流术。虽然不常见，但免疫功能正常宿主的隐球菌性脑膜炎可表现为梗阻性脑积水。它可导致迅速的神经功能衰退和死亡。紧急脑脊液分流和抗真菌治疗是主要的治疗方式。在某些情况下可能需要永久性的脑脊液分流。
