CHRONIC MENINGOENCEPHALITIS CAUSED BY CRYPTOCOCCUS GATTII IN AN IMMUNOCOMPETENT PATIENT IN THE AMAZONAS: A RARE CASE REPORT
DOI:
https://doi.org/10.66104/9v90zw02Keywords:
Neurocryptococcosis; C. Gatti; Immunocompetent; Amazonas; Antifungal therapyAbstract
Cryptococcosis is a rare but serious fungal infection caused by species of the genus Cryptococcus, notably Cryptococcus neoformans and Cryptococcus gattii. This paper aims to report a rare case of chronic meningoencephalitis caused by C. gattii in an immunocompetent patient in Amazonas, highlighting relevant clinical and epidemiological aspects for early diagnosis and treatment. The patient's condition worsened with visual and auditory symptoms. In May, after suspected papilledema, a brain MRI revealed indirect signs of intracranial hypertension. During hospitalization at HPS João Lúcio, the patient presented with nuchal rigidity and a focal seizure, and was transferred to FHAJ. Upon admission (May 15th), the patient presented with headache, fever, visual/auditory symptoms, neck pain, and cranial nerve abnormalities. CSF showed lymphocytic pleocytosis, hypoglycorrhachia, and elevated proteins, with a positive test for Cryptococcus gattii. Treatment was initiated with amphotericin B deoxycholate and fluconazole, progressing to severe hypokalemia and clinical deterioration, requiring transfer to the ICU. Liposomal amphotericin B and flucytosine were introduced, resulting in stabilization. After partial improvement, examinations showed hydrocephalus and cryptococcomas, and ventriculoperitoneal shunt was indicated. Prolonged induction treatment with antifungals and corticosteroid therapy followed. After 8 weeks, CSF was negative, and the consolidation phase with fluconazole was initiated. The patient was discharged with clinical improvement but with visual and auditory sequelae. This is a rare case of neurocryptococcosis caused by C. gattii in an immunocompetent patient. Analysis of the case report highlights the high pathogenicity of Cryptococcus gattii infection, with varied clinical manifestations and systemic complications, exhibiting greater cerebral tropism in immunocompetent patients. The importance of investigating differential diagnoses of meningoencephalitis is highlighted, focusing on a detailed medical history, valuing epidemiology, thorough physical examination, and specific laboratory tests, directly impacting clinical evolution.
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