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[Fulminating cryptococcal meningoencephalitis. An anatomo-clinical case]
P Vermersch1, D Leys, M Lorthioir
1Service de neurologie, Centre Hospitalier Universitaire, Lille.
Abstract:
We report a case of cryptococcal meningoencephalitis in a 52 year-old man. The patient had complained of headache and drowsiness for a few hours before he became comatose with a bilateral sixth cranial nerve palsy. The cerebrospinal fluid contained less than one lymphocyte per cubic millimeter, a low glucose level (0.20 g/l) and numerous Cryptococcus neoformans encapsulated yeasts. A neuropathological study showed that the cortex and midbrain were involved. To our knowledge, such an acute case with death within the first 20 hours has not yet been reported.
Insights
This case study details an extremely rapid and fatal case of cryptococcal meningoencephalitis in a 52-year-old man. The infection led to coma and death within 20 hours, highlighting the aggressive nature of this fungal brain infection.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Cryptococcal meningoencephalitis is a serious fungal infection of the brain.
- Cryptococcus neoformans is the primary causative agent, often seen in immunocompromised individuals.
- Rapid diagnosis and treatment are crucial for patient outcomes.
Observation:
- A 52-year-old male presented with acute headache and drowsiness, rapidly progressing to coma.
- Clinical examination revealed bilateral sixth cranial nerve palsy.
- Cerebrospinal fluid analysis showed lymphopenia, low glucose, and the presence of Cryptococcus neoformans yeasts.
Findings:
- Neuropathological examination confirmed involvement of the cortex and midbrain.
- The patient experienced a fulminant course, with death occurring within 20 hours of symptom onset.
- This represents an unusually rapid and fatal presentation of cryptococcal meningoencephalitis.
Implications:
- This case underscores the potential for extremely rapid disease progression in cryptococcal meningoencephalitis.
- It highlights the importance of prompt recognition and aggressive management, even in the absence of typical risk factors.
- Further research into factors influencing the speed of disease progression may be warranted.