Ryan Emily, Jackson Gia, Nichols Larry
Mercer University, School of Medicine, Department of Pathology and Clinical Science Education, Macon, GA, USA.
Autops Case Rep. 2024 Sep 27;14:e2024520. doi: 10.4322/acr.2024.520. eCollection 2024.
Cryptococcosis occurs primarily in immunocompromised patients. It is difficult to suspect in an immunocompetent patient presenting with a headache. The clinical manifestations of cryptococcosis can be subtle in a patient whose immune system is responding, but inadequate. This is the report of a case of fatal cryptococcosis initially misdiagnosed as a sinus headache on the basis of a telephone call, and then misdiagnosed as aseptic meningitis on the basis of mild findings and negative cerebrospinal fluid cultures. Autopsy revealed unsuspected severe cryptococcal meningoencephalitis. Cerebrospinal fluid nuclear acid amplification (NAA) panels including Cryptococcus should enable the diagnosis of unsuspected cryptococcal meningitis in most cases, but can be false positive, which could be adjudicated by cryptococcal antigen and culture. It will remain important to test for cryptococcal antigen and to maintain a broad differential diagnosis for all patients with meningitis.
隐球菌病主要发生在免疫功能低下的患者中。对于出现头痛的免疫功能正常的患者，很难怀疑其患有隐球菌病。在免疫系统有反应但功能不足的患者中，隐球菌病的临床表现可能很隐匿。本文报告了一例致命性隐球菌病病例，该病例最初基于电话问诊被误诊为鼻窦性头痛，随后基于轻微的检查结果和脑脊液培养阴性被误诊为无菌性脑膜炎。尸检发现了未被怀疑的严重隐球菌性脑膜脑炎。包括隐球菌检测在内的脑脊液核酸扩增（NAA）检测在大多数情况下应能诊断出未被怀疑的隐球菌性脑膜炎，但可能出现假阳性结果，这可通过隐球菌抗原检测和培养来判定。对所有脑膜炎患者进行隐球菌抗原检测并保持广泛的鉴别诊断仍然很重要。
