Cryptococcal meningitis with pulmonary cryptococcoma in an immunocompetent patient: A case report

Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons. Patient concerns: A 32 year old lady, active smoker presented with right chest pain, dry cough and loss of weight. Initial chest radiograph showed a lobulated lung mass in the right lower lobe. She developed headache and right cranial nerve palsy during admission. Various investigations were done including lumbar puncture, brain and chest imaging. Diagnosis: Cryptococcal meningitis with pulmonary cryptococcoma. Interventions: She received five months of effective antifungal treatment; however, the patient did not respond well. Subsequently, removal of pulmonary cryptococcoma was done. Outcomes: Her condition improved and she no longer had any headache. Lessons: Disseminated cryptococcosis is rare in immunocompetent patient. Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body, thus facilitating better response to antifungal therapy.

Cryptococcal meningitis with pulmonary cryptococcoma in an immunocompetent patient: A case report

Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons. Patient concerns: A 32 year old lady, active smoker presented with right chest pain, dry cough and loss of weight. Initial chest radiograph showed a lobulated lung mass in the right lower lobe. She developed headache and right cranial nerve palsy during admission. Various investigations were done including lumbar puncture, brain and chest imaging. Diagnosis: Cryptococcal meningitis with pulmonary cryptococcoma. Interventions: She received five months of effective antifungal treatment; however, the patient did not respond well. Subsequently, removal of pulmonary cryptococcoma was done. Outcomes: Her condition improved and she no longer had any headache. Lessons: Disseminated cryptococcosis is rare in immunocompetent patient. Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body, thus facilitating better response to antifungal therapy.

Criptococosis pulmonar y meníngea, en paciente inmunocompetente / Pulmonary and meningeal Cryptococcosis in an immunocompetent patient

La criptococosis es una enfermedad micótica oportunista, grave, causada por Cryptococcus neoformans. un hongo levaduriforme y encapsulado. Sus dos variedades; Cryptococcus neoformans variedad. neoformans (serotipos A y D) y Cryptococcus neoformans variedad. gattii (serotipos B y C) son responsables de enfermedad en el hombre. La infección ocurre por inhalación del microorganismo presente en el excremento principalmente de las palomas. Produce una infección pulmonar inicial desde donde se disemina a otros órganos sobre todo meninges y sistema nervioso central causando una meningoencefalitis; puede diseminarse a piel y vísceras. La criptococosis afecta con mayor frecuencia a personas inmunosuprimidas, en especial pacientes con SIDA. Presentamos el caso de una mujer de 40 años edad, sin antecedentes personales conocidos, a quien no se le conoce ningún estado de inmunosupresion, con serologías negativas para HIV; consultó al servicio de emergencia del Hospital General del Este, Dr Domingo Luciani, en la ciudad de Caracas, Venezuela. por clínica respiratoria de un mes de evolución, tos seca, cefalea, náuseas y vómitos. En el estudio radiológico de tórax se observó una imagen homogénea, radiopaca, que ocupaba el lóbulo superior de pulmón izquierdo. se le realizó fibrobroncoscopia con biopsia y lavado bronquial y los con hallazgos fueron sugestivos de criptococosis pulmonar. Además se realiza punción lumbar por sintomatología neurológíca, con reporte de criptolatex y tinta china positivo en LCR, demostrando el compromiso neurológico. Se planteó una criptococosis pulmonar con compromiso meníngeo(AU)

Cryptococcosis is a serious opportunistic fungal disease caused by Cryptococcus neoformans . There are two varieties; Cryptococcus neoformans var. neoformans (serotypes A and D) and Cryptococcus neoformans var. gattii (serotypes B and C) and they are responsible for human disease. Infection occurs by inhalation of microorganisms present in the feces mainly of pigeons. An initial pulmonary infection occurs and then it can spreads to other organs especially meninges and central nervous system causing meningoencephalitis; also to skin and vísceras. Cryptococcosis most often affects immunosuppressed people, especially AIDS patients. We present the case of a 40 year-old woman who consulted to the Emergency Service of the Hospital Dr Domingo Luciani, in Caracas, Venezuela. She had respiratory symptoms for a month as well as nausea and vomits; The chest radiograph showed a radiopaque homogeneous image in the left upper lobe of the lung. A bronchoscopy plus biopsy and washing was suggestive of pulmonary cryptococcosis . Because some neurological symptoms were present, a lumbar punction was performed and criptolatex reported positive in the CSF, diagnosing a disseminated cryptococcosis with meningeal involvement(AU)

Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia.

Idiopathic CD4 lymphocytopenia (ICL) is a rare disorder which is often diagnosed as HIV-negative AIDS in the light of poor immunity and AIDS-defining illnesses. We present a case of a 50-year-old male who presented with a midline posterior fossa tumour with ICL diagnosed as cerebellar cryptococcoma.

Meningoencefalitis por Criptococcus neoformans en escolares inmunocompetentes / Cryptococcus neoformans meningoencephalitis in inmunocompetent children

La meningoencefalitis por Cryptococcus neoformans, es la infección fúngica mas frecuente del sistema nervioso central, en personas afectadas por el virus de inmunodeficiencia humana (VIH). Es rara en niños inmunocompetentes y a menudo es fatal; predomina en el sexo masculino en una proporción de 3 a 1. Se describen los casos de dos escolares, uno masculino y otro femenino con antecedentes de contacto con palomas (Columba livia), cuyas manifestaciones clínicas fueron fiebre, cefalea, fotofobia, diplopía, ataxia y signos meníngeos con afectación unilateral del VI nervio craneal. El diagnóstico se estableció con el aislamiento del criptococo en cultivo, la tinción con tinta china y las pruebas de aglutinación en látex en el líquido cefalorraquídeo. La determinación de anticuerpos para virus de la inmunodeficiencia humana (VIH) y la cuantificación de linfocitos T CD4 y CD8 fueron normales. En el primer caso, la radiografía de tórax mostró una masa redondeada circunscrita en la mitad inferior del pulmón izquierdo y la resonancia magnética cerebral (RNM) reveló una imagen nodular compatible con un criptococoma en la región parietal derecha; se estableció un cuadro de hipertensión endocraneana, con edema de papila y amaurosis bilateral con evolución no satisfactoria y posterior fallecimiento. El segundo caso tuvo una evolución favorable. Ambos recibieron tratamiento con anfotericina B (1 mg/kg/día) y fluconazol (6 mg/kg/día). El Cryptococcus neoformans no es un hongo usual en niños inmunocompetentes. La detección precoz de la enfermedad y el tratamiento adecuado es fundamental para lograr un mejor pronóstico de la enfermedad.

Cryptococcus neoformans meningoencephalitis is the most common fungal central nervous system infection, in people affected by the human immunodeficiency virus. It is rare in inmunocompetent children and it is often fatal. It predominates in males at a ratio of 3 to 1. We describe the cases of two school children, one male and one female, with history of contact with pigeons (Columba livea), whose clinical symptoms were fever, headache, photophobia, diplopia, ataxia and meningeal signs, with unilateral involvement of cranial nerve VI. The diagnosis was established by the isolation of Cryptococcus neoformans in culture, staining with India ink and evidence of latex antigen agglutination in the cerebrospinal fluid. The determination of antibodies to human immunodeficiency virus and quantification of CD4, CD8 and T lymphocyte cells, were normal. In the first case, a chest X-ray showed a round mass, circumscribed in the bottom half of the left lung. A brain MRI revealed an image compatible with a nodular cryptococcoma in the parietal region. A pattern of intracranial hypertension was established, with papilledema and bilateral amaurosis, that evolved unsatisfactorily, with the subsequent death of the patient. Both were treated with amphotericin B (1 mg/Kg/day) or fluconazole (6 mg/Kg/day). The second case had a favorable evolution. The Crypotococcus neoformans is not a common fungus in inmunocompetent children. Early detection of the disease and appropriate treatment is essential to achieve a better prognosis ot the disease.