Successful treatment of cerebral cryptococcoma and meningitis with miconazole

Area of Science:

• Mycology
• Infectious Diseases
• Neurology

Background:

• Pulmonary cryptococcosis can lead to disseminated disease, including cryptococcal meningitis and cerebral lesions.
• Surgical removal of infected lung tissue may not prevent central nervous system involvement.

Observation:

• A patient with pulmonary cryptococcosis developed cryptococcal meningitis and a cerebral cryptococcoma post-lung surgery.
• Initial treatment with amphotericin B and flucytosine was ineffective in clearing the infection or improving neurological symptoms.

Findings:

• Miconazole therapy successfully eradicated the fungal infection, resolving the meningitis and cerebral lesion.
• Serial computed tomographic scans confirmed the disappearance of the brain lesion.
• The patient experienced a complete neurological recovery and remained relapse-free for five years.

Implications:

• Miconazole represents a potential therapeutic option for refractory cryptococcal meningitis with cerebral involvement.
• This case highlights the importance of considering alternative antifungal agents when standard treatments fail.
• Long-term follow-up is crucial for assessing treatment efficacy and preventing relapse in cryptococcosis.