Ohira Kenji, Kawarada Yo, Iwata Ryoko, Satake Mitsuo
Department of Radiology, Shin-Kuki General Hospital, , 418-1 Kamihayami, Kuki City, Saitama Prefecture 346-8530.
Radiol Case Rep. 2024 Sep 6;19(12):5579-5585. doi: 10.1016/j.radcr.2024.08.027. eCollection 2024 Dec.
Cryptococcal meningitis is one of the most common fungal meningitis in adults and causes disabling morbidity and mortality worldwide. The occurrence of postinfectious inflammatory response syndrome during cryptococcal meningitis treatment presents a diagnostic challenge. This time course seems paradoxical because patients show worsening symptoms and imaging findings. However, laboratory data improve with antifungal treatments. Herein, we present a case of an older woman diagnosed with cryptococcal meningitis who later developed postinfectious inflammatory response syndrome. Despite the initial antifungal treatment and improvements in cerebrospinal fluid analysis results, the patient's neurological condition deteriorated; imaging findings worsened. Magnetic resonance imaging at the time of postinfectious inflammatory response syndrome showed more prominent meningeal enhancement and brain edema, consistent with postinfectious inflammatory response syndrome, combined with negative repeat cerebrospinal fluid cultures for cryptococcal species. This case highlights the importance of considering postinfectious inflammatory response syndrome when patients with cryptococcal meningitis show clinical worsening during treatment. Prompt corticosteroid therapy significantly improves patient outcomes. Radiologists and clinicians should be aware of postinfectious inflammatory response syndrome to provide appropriate therapeutic options and improve prognosis in patients with cryptococcal meningitis.
隐球菌性脑膜炎是成人中最常见的真菌性脑膜炎之一，在全球范围内导致致残性发病和死亡。隐球菌性脑膜炎治疗期间发生的感染后炎症反应综合征带来了诊断挑战。这个时间过程似乎自相矛盾，因为患者症状和影像学表现恶化。然而，实验室数据随着抗真菌治疗而改善。在此，我们报告一例老年女性诊断为隐球菌性脑膜炎，后来发展为感染后炎症反应综合征。尽管最初进行了抗真菌治疗且脑脊液分析结果有所改善，但患者的神经状况恶化；影像学表现恶化。感染后炎症反应综合征发生时的磁共振成像显示脑膜强化和脑水肿更明显，符合感染后炎症反应综合征，同时隐球菌属的重复脑脊液培养结果为阴性。该病例强调了在隐球菌性脑膜炎患者治疗期间出现临床恶化时考虑感染后炎症反应综合征的重要性。及时给予皮质类固醇治疗可显著改善患者预后。放射科医生和临床医生应了解感染后炎症反应综合征，以便为隐球菌性脑膜炎患者提供适当的治疗选择并改善预后。
