RESUMO
Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.
Assuntos
Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Meningite Criptocócica/tratamento farmacológico , Infecção Puerperal/tratamento farmacológico , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Meningite Criptocócica/diagnóstico , Infecção Puerperal/diagnósticoRESUMO
Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.
Assuntos
Adulto , Feminino , Humanos , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Meningite Criptocócica/tratamento farmacológico , Infecção Puerperal/tratamento farmacológico , Imageamento por Ressonância Magnética , Meningite Criptocócica/diagnóstico , Infecção Puerperal/diagnósticoRESUMO
We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.