Watanabe Apapatra Akiko, Hemachudha Pasin, Rattanawong Wanakorn, Pongpitakmetha Thanakit
Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi 11120, Thailand.
IDCases. 2022 Aug 17;29:e01602. doi: 10.1016/j.idcr.2022.e01602. eCollection 2022.
Cryptococcal meningoencephalitis often occurs in an immunocompromised host with several known neurological manifestations including space-occupying lesions, meningitis or meningoencephalitis. Here, we describe a 38-year-old previously healthy durian farm owner with cryptococcoma and subsequent development of cryptococcus gelatinous pseudocyst after receiving high doses of intravenous dexamethasone to treat mass lesion presumed to be a malignant process. An MRI scan of the head demonstrated a 2-cm heterogeneous solitary enhancing cystic lesion at the right thalamus. Progression of neurological deficit and another repeat imaging showing typical appearance of gelatinous pseudocyst. Lumbar puncture found markedly elevated pressure and cryptococcal antigen strongly positive confirming the diagnosis. He was immediately started on amphotericin B and flucytosine for cryptococcus meningoencephalitis with partial improvement in his vision. This report highlights consideration of cryptococcal infection in an immunocompetent host to avoid delays in diagnosis and treatment.
隐球菌性脑膜脑炎常发生于免疫功能低下的宿主，有多种已知的神经学表现，包括占位性病变、脑膜炎或脑膜脑炎。在此，我们描述一名38岁以前健康的榴莲农场主，患有隐球菌瘤，在接受高剂量静脉注射地塞米松治疗推测为恶性病变的肿块后，随后出现隐球菌性胶样假囊肿。头部MRI扫描显示右侧丘脑有一个2厘米的异质性孤立性强化囊性病变。神经功能缺损进展，再次进行的影像学检查显示为典型的胶样假囊肿表现。腰椎穿刺发现压力明显升高，隐球菌抗原强阳性，确诊为此病。他立即开始接受两性霉素B和氟胞嘧啶治疗隐球菌性脑膜脑炎，视力有部分改善。本报告强调在免疫功能正常的宿主中考虑隐球菌感染，以避免诊断和治疗的延误。
