1/73. Pontine cryptococcoma in a nonimmunocompromised individual: MRI characteristics.The case of a pontine cryptococcoma in a nonimmunocompromised, previously healthy 16-year-old boy is presented. The patient had slowly progressive brainstem signs with right cranial nerves V, VII, and VIII palsies, and contralateral corticospinal and spinothalamic deficits. Magnetic resonance images (MRI) revealed, within the right pons, a 1-cm diameter round mass lesion, hypointense on T1-weighted images, hyperintense on T2-weighted images, and with rim enhancement after infusion of gadopentetate dimeglumine. This is the only report of the MRI findings in an isolated pontine cryptococcoma in an immunocompetent patient. Early recognition of this specific MRI pattern is essential, because complete recovery can be achieved with prompt antifungal treatment.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/73. Primary cryptococcal prostatitis in an apparently uncompromised host.BACKGROUND: Systemic spread from a primary focus of cryptococcal infection commonly involves the central nervous system, manifested as meningitis or meningoencephalitis. Untreated meningitis and meningoencephalitis are invariably fatal, following a subacute or chronic course of cyclic remission and relapse, followed by progressive deterioration over weeks to months. Occasional patients with fulminating meningoencephalitis die within a few days. Incorrect diagnosis may be the most common cause of fatality in this disease. Thorough histopathologic examination and blood and body fluid studies should minimize misdiagnosis. methods: We studied the case of an initially misdiagnosed 64-year-old apparently immunologically competent man with primary cryptococcal prostatitis that subsequently disseminated to the central nervous system and the left eye. All immunologic findings including workup for AIDS viruses were normal. Laboratory studies confirmed cryptococcal infection. RESULTS: After initial misdiagnosis, our patient received improper treatment for 10 months. He developed meningitis and severe left endophthalmitis with optic nerve and retinal involvement. Toxic medications led to kidney insufficiency with about 66% loss of function. Following therapy, reevaluation of his immune system showed marked abnormality in cell-mediated immunity. CONCLUSIONS: cryptococcosis is easily misdiagnosed in uncompromised hosts, both clinically and pathologically, because of misconception that the disease affects only immunocompromised individuals and that primary cryptococcal prostatitis is virtually unheard-of in "normal" males.- - - - - - - - - - ranking = 142.67821196926keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/73. Fatal biphasic brainstem and spinal leptomeningitis with cryptococcus neoformans in a non-immunocompromised child.Cryptococcal meningitis is one of the most common life-threatening, invasive fungal infections of the central nervous system in patients with defective T-lymphocyte function. It is, however, unusual in children. We report on a non-immunocompromised 10-y-old boy without evidence of immunological abnormality who developed headache, vomiting, disturbances of consciousness and areflexia. magnetic resonance imaging of the brain and the spinal cord revealed enlargement of the ventricles and high signal lesions in the leptomeninges at the level of the cerebral peduncles and the cervical and thoracic cord. cerebrospinal fluid analysis was positive for cryptococcus neoformans. He was treated with amphotericin b and was symptom-free within 1 wk. Despite an extended course of therapy his symptoms suddenly relapsed and he succumbed to the medical complications of cardiac and respiratory failure. central nervous system appearances at postmortem were those of cryptococcal leptomeningitis.- - - - - - - - - - ranking = 93.23792055904keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
4/73. Intramedullary spinal cryptococcoma: a case report.Intramedullary spinal cryptococcosis is very rare. We describe a case of intramedullary spinal cryptococcoma at the T12 level in a 60-year-old man who presented with a 3-month history of progressive bilateral lower limb weakness and no obvious immunocompromise. Magnetic resonance (MR) imaging revealed a 1.2 cm diameter mass within the spinal cord at T12 with intermediate signal intensity on T1-weighted images, a slight degree of homogeneous low signal intensity on T2-weighted images, and intense enhancement after infusion of gadopentetate dimeglumine. These findings led to a preoperative diagnosis of intramedullary tumor. After 2 months of postoperative antifungal treatment, the patient's clinical condition had markedly improved. Cryptococcoma should be considered when an enhancing lesion of the spinal cord is found on MR imaging, even in apparently immunocompetent patients. A careful lumbar puncture for cerebrospinal fluid analysis to diagnose cryptococcosis of the central nervous system should be made promptly, as early treatment is associated with a good prognosis.- - - - - - - - - - ranking = 71.33910598463keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/73. Intramedullary abscess resulting from disseminated cryptococcosis despite immune restoration in a patient with AIDS.We report on a case of cryptococcal intramedullary abscess, which occurred three years after a disseminated cryptococcosis and two years after a lymph node cryptococcal recurrence in a hiv-infected patient who exhibited a long-standing immune restoration. At the time of diagnosis, CD4( ) lymphocyte-count was 640x10(6)/l and hiv viral load was undetectable. Spinal involvement is rare during cryptococcosis of the central nervous system. As far as we are aware, there is only one case of proven intramedullary cryptococcal abscess reported in the literature and this case is then the second one. The significant and sustained increase in CD4 count following effective antiretroviral therapy was probably associated with only a partial immune restitution that did not allow to avoid the occurrence of the cryptococcal medullar abscess. Finally, this case raises the question of when to stop secondary prophylaxis of cryptococcal disease after increase in CD4 cell count under antiretroviral therapy.- - - - - - - - - - ranking = 71.33910598463keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/73. Cryptococcal infection in sarcoidosis.A 48-year-old man with a history of sarcoidosis was transferred to the Mayo Clinic for evaluation and management of progressive neurologic decline. Two years before admission, he was admitted to a local hospital with mental status changes accompanied by ataxia and severe headache. A diagnosis of pulmonary and central nervous system sarcoidosis was made based on computed tomography of the head, lumbar puncture, and chest radiography. A mediastinoscopy with lymph node biopsy exhibited noncaseating granulomas and negative stains for microorganisms. prednisone therapy was initiated at 80 mg/day. Clinical improvement was apparent for 13 months during steroid therapy until the slow taper reached a dosage of 20 mg/day. At that time, the patient was readmitted to the local hospital with severe confusion and skin lesions. When intravenous methylprednisolone therapy for presumed central nervous system sarcoidosis did not improve the patient's mental status, he was transferred to the Mayo Clinic. physical examination of the thighs revealed large, well-marginated, indurated, irregularly bordered, violaceous plaques and rare, umbilicated, satellite papules with central hemorrhagic crusts (Fig. 1A). Superficially ulcerated plaques with a similar appearance to the thigh lesions were coalescing around the lower legs (Fig. 1B). A skin biopsy specimen of the thigh demonstrated abundant numbers of encapsulated organisms and minimal inflammatory response (Fig. 2). skin, blood, and cerebrospinal fluid cultures confirmed the presence of cryptococcus neoformans. Amphotericin and flucytosine combination therapy was initiated, and steroid dosages were gradually tapered. A test for human immunodeficiency virus was negative. The patient was dismissed from hospital after a complicated 2-month course resulting in improved mental status but progression of the lower extremity ulcerations as a result of polymicrobial infection.- - - - - - - - - - ranking = 142.67821196926keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/73. Cryptococcal infection of the larynx simulating laryngeal carcinoma.cryptococcus neoformans is an encapsulated yeast that can cause primary pulmonary infections or disseminate and cause infections of the central nervous system, meninges, skin, and bone in the immunocompromised host. We present here an unusual case of an immunocompetent patient who had laryngitis due to C. neoformans that mimicked a laryngeal carcinoma on clinical examination and imaging studies.- - - - - - - - - - ranking = 71.33910598463keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/73. meningitis due to prototheca wickerhamii in a patient with AIDS.The first documented case of algal meningitis due to prototheca wickerhamii is reported in a patient with AIDS. The initial CSF culture yielded only cryptococcus neoformans. P. wickerhamii was isolated on four subsequent lumbar punctures. The patient died, and at autopsy the alga was isolated from leptomeninges over the brain and about the spinal cord. Histologic sections from numerous locations of the brain revealed masses of cryptococci and prototheca.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
9/73. Asymptomatic pulmonary cryptococcosis in solid organ transplantation: report of four cases and review of the literature.cryptococcus neoformans is the third most common cause of invasive fungal infections in solid organ transplantation. The infection generally presents as disseminated disease, involving multiple sites including the central nervous system, lungs, and skin. An increase in the incidence of primary pulmonary cryptococcal infections has been reported recently in solid organ recipients; these infections were generally symptomatic with an accelerated clinical course. We report four cases of asymptomatic pulmonary cryptococcosis in solid organ recipients (kidney, n=2, heart, n=2). In each case, an incidental finding on a routine chest radiograph led to the microbiological or histopathological diagnosis of invasive pulmonary C. neoformans infection. In these patients, cryptococcosis occurred a median of 25 months (range 7-36 months) after organ transplantation. All patients had a calcineurin inhibitor, prednisone, and azathioprine or mycophenolate mofetil as part of their immunosuppressive therapy at the time of diagnosis. serum cryptococcal antigen was available and positive in the three patients studied; assessment of cerebrospinal fluid (CSF) of all four patients revealed no organisms by smear or culture. Therapy consisted of oral fluconazole in all cases, with flucytosine in one case, combined with resection of lung tissue in two individuals. All patients have remained free of cryptococcal disease (follow-up median 42 months, from 18 to 88 months). Cryptococcal disease in solid organ recipients may present as asymptomatic, localized pulmonary disease. The natural history of such infections is unknown. New pulmonary radiographic findings should prompt an aggressive diagnostic evaluation including serum and CSF cryptococcal antigen assays, and a biopsy of pulmonary lesions. Prolonged therapy may be used to reduce the risk of progression and dissemination during periods of intensified immune suppression.- - - - - - - - - - ranking = 71.33910598463keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/73. Cutaneous cryptococcosis in a diabetic renal transplant recipient.A diabetic renal transplant recipient with cellulitis caused by cryptococcus neoformans, serotype A, is described. The diagnosis was based on the demonstration of capsulated, budding yeast cells in the aspirated material and tissue from the cellulitic lesion and isolation of the aetiological agent in culture. The isolate formed well-developed capsules in the brain tissue of experimentally infected mice and produced cherry-brown colonies on niger seed medium. The patient's serum was positive for cryptococcal antigen (titre 1 : 4) with no other evidence of systemic infection. He was successfully treated with AmBisome, followed by fluconazole, resulting in the complete resolution of cellulitis and disappearance of the cryptococcal antigen. This report underscores the fact that patients with cutaneous cryptococcosis should be thoroughly evaluated, as it may be the first manifestation of a systemic disease. Prompt diagnosis and treatment are important to improve survival.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
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