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Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non-immunocompromised child
M Ruggieri1, A Polizzi, M C Vitaliti
1Department of Paediatrics, IBFSNC, CNR, University of Catania, Italy.
Abstract:
Cryptococcal meningitis is one of the most common life-threatening, invasive fungal infections of the central nervous system in patients with defective T-lymphocyte function. It is, however, unusual in children. We report on a non-immunocompromised 10-y-old boy without evidence of immunological abnormality who developed headache, vomiting, disturbances of consciousness and areflexia. Magnetic resonance imaging of the brain and the spinal cord revealed enlargement of the ventricles and high signal lesions in the leptomeninges at the level of the cerebral peduncles and the cervical and thoracic cord. Cerebrospinal fluid analysis was positive for Cryptococcus neoformans. He was treated with amphotericin B and was symptom-free within 1 wk. Despite an extended course of therapy his symptoms suddenly relapsed and he succumbed to the medical complications of cardiac and respiratory failure. Central nervous system appearances at postmortem were those of cryptococcal leptomeningitis.
Insights
Cryptococcal meningitis is rare in children, but this case highlights a fatal outcome in a non-immunocompromised boy. Early treatment showed promise, but relapse led to death from central nervous system fungal infection.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Cryptococcal meningitis is a severe fungal infection of the central nervous system, typically affecting immunocompromised individuals.
- It is uncommonly diagnosed in pediatric populations, making its presentation and progression in children less understood.
- T-lymphocyte dysfunction is a primary risk factor for invasive fungal infections like cryptococcosis.
Observation:
- A 10-year-old boy with no known immunological abnormalities presented with severe neurological symptoms including headache, vomiting, altered consciousness, and areflexia.
- Neuroimaging revealed ventricular enlargement and leptomeningeal lesions in the brain and spinal cord.
- Cerebrospinal fluid analysis confirmed the presence of Cryptococcus neoformans.
Findings:
- The patient initially responded to amphotericin B treatment, with symptom resolution within one week.
- Despite a prolonged treatment course, the patient experienced a sudden relapse of cryptococcal meningitis.
- The relapse resulted in fatal cardiac and respiratory failure, with postmortem examination confirming central nervous system cryptococcal leptomeningitis.
Implications:
- This case underscores the potential for severe cryptococcal meningitis even in immunocompetent children.
- It highlights the critical need for heightened awareness and diagnostic vigilance for invasive fungal infections in pediatric neurology.
- The case emphasizes the challenges in managing relapsed cryptococcal meningitis and the importance of long-term monitoring and potentially novel therapeutic strategies.