Subject(s)
Fetal Therapies/methods , Meningomyelocele/surgery , Neurosurgical Procedures/methods , Pain, Procedural/physiopathology , Stress, Physiological/physiology , Adjuvants, Anesthesia/therapeutic use , Adrenergic alpha-1 Receptor Agonists/therapeutic use , Analgesics, Opioid/therapeutic use , Anesthesia, General/methods , Anesthetics, Inhalation/therapeutic use , Atropine/therapeutic use , Female , Fentanyl/therapeutic use , Humans , Injections, Intramuscular , Medication Errors , Neuromuscular Nondepolarizing Agents/therapeutic use , Pain, Procedural/prevention & control , Phenylephrine/therapeutic use , Pregnancy , Pregnancy Trimester, Second , Remifentanil/therapeutic use , Sevoflurane/therapeutic use , Vecuronium Bromide/therapeutic useABSTRACT
BACKGROUND: Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging. CASE DESCRIPTION: A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required. CONCLUSIONS: This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.
