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Case of the month: July 1997--diabetic male with transient ischemic attacks
1Department of Pathology, US Department of Veteran's Affairs Medical Center, La Jolla, CA.
Abstract:
A 60-year-old diabetic male presented with transient ischemic attacks. Initial neurological examination and head CT were normal. Dysarthria, ataxia, delirium, and lethargy developed. A diagnosis of cryptococcal meningitis was made after lumbar puncture and treatment with intravenous amphotericin B and 5-fluorcytosine was begun. A repeat head CT showed an anterior cerebral artery territory infarct. His condition worsened and he died of associated complications three weeks after admission. The case is used to discuss the association between cryptococcal meningitis and diabetes, transient ischemic attacks, and vasculitis with cerebral infarction.
Insights
This case highlights the severe risks of cryptococcal meningitis in diabetic patients, even after initial normal tests. The infection can lead to stroke and death, emphasizing the need for prompt diagnosis and treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Diabetology
Background:
- Cryptococcal meningitis is a serious fungal infection, particularly concerning in immunocompromised individuals.
- Diabetes mellitus is a known risk factor for various infections, potentially increasing susceptibility to opportunistic pathogens like Cryptococcus.
Observation:
- A 60-year-old male with diabetes presented with transient ischemic attacks (TIAs).
- Initial neurological exams and head CT were unremarkable, but the patient later developed severe neurological symptoms including dysarthria, ataxia, delirium, and lethargy.
- Lumbar puncture confirmed cryptococcal meningitis, leading to treatment with intravenous amphotericin B and 5-fluorocytosine.
Findings:
- Despite treatment, the patient experienced a cerebral infarction in the anterior cerebral artery territory, confirmed by repeat head CT.
- The patient's condition deteriorated, resulting in death three weeks after admission due to complications of the infection and stroke.
Implications:
- This case underscores the critical association between cryptococcal meningitis, diabetes, and cerebrovascular events such as TIAs and cerebral infarction.
- It highlights the potential for rapid progression and severe outcomes, including vasculitis, in diabetic patients with cryptococcal meningitis.
- Early and accurate diagnosis of cryptococcal meningitis is crucial, especially in diabetic patients presenting with neurological symptoms, to prevent devastating complications.