SYNOPSIS A case of cryptococcal meningo-encephalitis is described. Treatment with the fungicidal agent amphotericin B resulted in temporary improvement, but the patient relapsed and died 17 months after diagnosis. The pathology and treatment of the disease are discussed.The incidence of meningo-encephalitis due to infection with the yeast-like organism Cryptococcus neoformans remains low in Britain but cases have been recognized with increasing frequency in recent years. The fungicidal agent amphotericin B has proved to be the most effective drug yet available for the treatment of this condition, but there have so far been few published reports of its use in cases arising in this country.We present here a clinico-pathological report of a case of cryptococcal meningo-encephalitis in a man who had never been abroad and died of the disease 17 months after diagnosis in spite of an encouraging initial response to treatment with amphotericin B.
CASE REPORTThe patient, a man aged 60 years, was admitted to hospital in August 1962 with four weeks' history of severe and increasing frontal headache, mainly affecting the right side. There was also a history of discharge from the left ear for many years, and this had recently increased in severity. On examination he was found to be confused, disorientated, pyrexial, and obviously in severe pain. There was a profuse purulent discharge from the left ear, papilloedema mainly affecting the left eye, and diplopia on looking to the left. The left plantar reflex was extensor and there was an area of sensory impairment over the right foot. On the basis of the clinical history and physical signs, cerebral abscess secondary to chronic suppurative otitis media appeared at this stage to be the most likely diagnosis.Radiological examination of the skull showed a densely sclerotic left mastoid process suggestive of chronic infection, but ventriculography showed no evidence of cerebral abscess. Lumbar puncture showed that the cerebrospinal fluid was under a pressure of more than 300 mm. The fluid contained 300 red cells and 66 lymphocytes per c.mm. The protein, sugar, and chloride levels were respectively 120 mg., 34 mg., and 710 mg. per 100 ml.
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