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Cryptococcal cerebellitis in no-VIH patient
Fabricio Andres Lasso1, Tomas Omar Zamora Bastidas2, Jorge Andrés Potosí García1
1Facultad de Medicina, Universidad del Cauca. Cauca, Colombia.
Introduction:
Cryptococcosis is an opportunistic fungal infection whose etiology is Cryptococcus neofromans / C. gattii, complex which affects immunocompromised patients mainly. Meningeal infection is one of the most common presentations, but cerebellar affection is rare.
Case Description:
Male patient with 65 old years, from an area of subtropical climate with chronic exposure to poultry, without pathological antecedents, who presented clinical picture consistent with headache, fever, seizures and altered mental status.
Clinical Findings And Diagnostic Methods:
Initially without menigeal signs or intracranial hypertension and normal neurological examination. Later, the patient developed ataxia, dysdiadochokinesia and limb loss. By lumbar punction and image of nuclear magnetic resonance (NMR) cerebellitis cryptococcal was diagnosticated.
Treatment:
Antifungal therapy with amphotericin B and fluconazole was performed, however the patient died.
Clinical Relevance:
The cryptococcosis has different presentations, it´s a disease whose incidence has been increasing since the advent of the HIV / AIDS pandemy, however the commitment of the encephalic parenchyma and in particular the cerebellum is considered rare. In this way we are facing the first case of cryptococcal cerebellitis in our midst.
Insights
Cryptococcal cerebellitis is a rare opportunistic infection. This case highlights a fatal instance in a 65-year-old male, emphasizing the need for awareness of unusual presentations of cryptococcosis.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Cryptococcosis, caused by Cryptococcus neoformans / C. gattii, is an opportunistic fungal infection primarily affecting immunocompromised individuals.
- While meningeal involvement is common, cerebellar cryptococcosis is exceptionally rare.
Observation:
- A 65-year-old male with chronic poultry exposure presented with headache, fever, seizures, and altered mental status.
- Initial examination showed no meningeal signs or intracranial hypertension, but the patient later developed ataxia and dysdiadochokinesia.
- Diagnosis of cryptococcal cerebellitis was confirmed via lumbar puncture and Magnetic Resonance Imaging (MRI).
Findings:
- The case describes a rare instance of cryptococcal cerebellitis.
- Despite antifungal therapy with amphotericin B and fluconazole, the patient succumbed to the infection.
- This represents the first reported case of cryptococcal cerebellitis in the region.
Implications:
- Cryptococcosis incidence is rising, particularly with the HIV/AIDS pandemic.
- Cerebral parenchymal and cerebellar involvement in cryptococcosis are uncommon but serious presentations.
- Increased recognition of atypical cryptococcal infections is crucial for timely diagnosis and management.
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