Meningoencephalitis and optical neuritis caused by CRYPTOCOCCUS GATTII in an immunocompetent patient

  • Beatriz Antunes de Souza University of Uberaba - UNIUBE, Uberaba, Minas Gerais, Brazil, revpatoltrop@yahoo.com.br
  • Luiz Carlos Silva Souza Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br
  • Adriana Oliveira Guilarde Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br
  • Alexandre Augustus Costa Barbosa State Health Secretariat, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br
  • Luiz Alves Ferreira Filho Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br
  • Marta Antunes de Souza Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

Abstract

The following case is of a 59-year-old man, undergoing no medication, with no pathological history or others risk factors, who presented dizziness, fever and asthenia twenty days before admission. The patient was admitted for investigation when the asthenia intensified, followed by seizures. On admission, blood count, biochemical tests and chest computed tomography were normal, a serological test for anti-HIV proved negative, while the magnetic resonance of the brain showed signs suggestive of meningoencephalitis. Cerebrospinal fluid (CSF) analysis suggested bacterial meningitis due to increased leukocytes with a predominance of polymorphonuclear cells, reduced glucose and increased proteins as well as positive Gram cocci in pairs by Gram and negative fungi by India ink test. Treatment with ceftriaxone was started. Since there was no significant improvement, CSF analysis was repeated on the seventh day of treatment. Intracranial pressure was measured by manometry (29 mmHg) and CSF analysis showed the presence of encapsulated yeasts similar to Cryptococcus neoformans by the India ink test. The treatment was modified to liposomal amphotericin B and flucytosine; the intracranial hypertension was controlled by repeated CSF punctures. After fourteen days of antifungal treatment, the patient presented visual turbidity and bilateral papillar edema, so corticosteroid therapy was prescribed. The evolution was favorable, with progressive resolution of symptoms, improvement of CSF parameters and visual acuity. The patient was discharged eight weeks after admission, with outpatient guidance. Corticosteroid therapy associated with antifungal therapy proved to be beneficial in this case, since following the introduction of corticosteroids there was progressive visual improvement.
KEY WORDS: Neurocryptococcosis; Cryptococcus gattii; ocular involvement; optic neuritis

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Author Biographies

Beatriz Antunes de Souza, University of Uberaba - UNIUBE, Uberaba, Minas Gerais, Brazil, revpatoltrop@yahoo.com.br

Medical student at the University of Uberaba (UNIUBE), Uberaba, MG, Brazil.

Luiz Carlos Silva Souza, Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

1. Department of Tropical Medicine and Dermatology, Institute of Tropical Pathology and Public Health, Federal University of Goiás (UFG), Goiania, GO, Brazil.
2. Anuar Auad Hospital, Tropical Diseases Hospital, State Health Secretariat, Goiania, GO, Brazil.

Adriana Oliveira Guilarde, Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

Department of Tropical Medicine and Dermatology, Institute of Tropical Pathology and Public Health, Federal University of Goiás (UFG), Goiania, GO, Brazil.

Alexandre Augustus Costa Barbosa, State Health Secretariat, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

Anuar Auad Hospital, Tropical Diseases Hospital, State Health Secretariat, Goiania, GO, Brazil.

Luiz Alves Ferreira Filho, Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

Department of Radiology and Diagnostic Imaging, Medical School, UFG, Goiania, GO, Brazil.

Marta Antunes de Souza, Federal University of Goiás - UFG, Goiania, Goiás, Brazil, revpatoltrop@yahoo.com.br

Department of Tropical Medicine and Dermatology, Institute of Tropical Pathology and Public Health, Federal University of Goiás (UFG), Goiania, GO, Brazil.

Published
21-12-2020
How to Cite
Antunes de Souza, B., Carlos Silva Souza, L., Oliveira Guilarde, A., Augustus Costa Barbosa, A., Alves Ferreira Filho, L., & Antunes de Souza, M. (2020). Meningoencephalitis and optical neuritis caused by CRYPTOCOCCUS GATTII in an immunocompetent patient. Revista De Patologia Tropical / Journal of Tropical Pathology, 49(4), 265-273. https://doi.org/10.5216/rpt.v49i4.67163
Section
RELATO DE CASO / CASE REPORT