Paciente inmunocompetente con criptococosis cerebral: reporte de un caso.

Area of Science:

• Neurology
• Infectious Diseases
• Mycology

Background:

• Cryptococcus neoformans is an opportunistic fungal pathogen that can cause life-threatening meningoencephalitis, particularly in immunocompromised individuals.
• Early diagnosis and prompt treatment are crucial for improving outcomes in patients with cryptococcal meningitis.

Observation:

• A 14-year-old female presented with sudden holocraneal headache, vomiting, and acute confusional state, suggestive of meningoencephalitis.
• Cerebrospinal fluid analysis revealed low glucose, elevated proteins, and a cell count of 15/mm, with positive India ink and Cryptococcus neoformans cultures.
• Initial brain CT scan was normal, underscoring the limitations of neuroimaging in early cryptococcal meningitis detection.

Findings:

• Despite treatment with fluconazole, amphotericin-B, and dexamethasone, the patient rapidly progressed to cerebral edema and multiple-organ failure.
• The case highlights a fatal outcome despite aggressive antifungal and anti-inflammatory therapy, emphasizing the aggressive nature of disseminated cryptococcosis.

Implications:

• This case underscores the significant public health challenge posed by Cryptococcus spp. infections, especially in vulnerable populations.
• It emphasizes the need for heightened awareness and diagnostic vigilance for fungal meningoencephalitis in immunocompromised patients presenting with neurological symptoms.
• The report calls for improved strategies for managing cryptococcal infections in resource-limited settings, particularly in Mexico.