Neurocriptococose durante a gravidez: revisão da literatura. Relato de dois casos

Pereira, Carlos Alberto Pires; Fischman, Olga; Colombo, Arnaldo Lopes; Moron, Antônio Fernandes; Pignatari, Antônio Carlos Campos

doi:10.1590/s0036-46651993000400011

Cited by 11 publications

(5 citation statements)

References 14 publications

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“…Although several cases of cryptococcal meningitis in immunocompetent pregnant women have been described 5,6 , to our knowledge, only two cases of cryptococcoma during pregnancy have been previously reported 7,8 . The presence of antecedent symptoms six years before this illness suggests the possibility of a prior infection that was spontaneously controlled until recrudescence and growth of the cryptococcoma during the relative immunosuppression of pregnancy, in which cell-mediated immunity is particularly affected.…”

Section: Discussionmentioning

confidence: 87%

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Hagan¹,

Dias

Bisneto

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.

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Section: Discussionmentioning

confidence: 87%

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Hagan¹,

Dias

Bisneto

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…However, even immunocompetent patients can be affected by CNS cryptococcosis, with high levels of mortality [5]. Pregnant women have been one group of patients affected by cryptococcosis, not only in CNS [8,9,[12][13][14] but also as cryptococcal pneumonia [15] or osteomyelitis [16].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it has also been reported that a woman diagnosed with cryptococcoma in the immediate postpartum period, with intolerance to amphotericin (body rash and severe hypokalemia and hypomagnesemia with ventricular arrhythmia), was also successfully treated with high-dose fluconazole monotherapy [12]. Fortunately, pregnant women who are correctly diagnosed and treated usually have a favorable prognosis, with no consequences to the fetus [8,14]. Transplacental transmission of Cryptococcus is rare [9], although it has been described, mostly in HIVinfected pregnant women [22].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis in an HIV-Negative Puerperal Woman

Nunes

Pires

Alves

et al. 2021

Case Reports in Infectious Diseases

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Cryptococcal meningitis is a common opportunistic infection in HIV-infected patients and other immunocompromised people. Pregnancy, which is a state of relative immunosuppression, can also be a risk factor for the development of cryptococcal meningitis. We report a clinical case of a 41-year-old woman who developed a severe meningeal syndrome after an otherwise normal pregnancy. Cerebrospinal fluid (CSF) cytochemical analysis presented hypoglycorrhachia, high protein levels, and pleocytosis. Cryptococcal antigen tested positive in serum and CSF, and Cryptococcus neoformans was identified in the CSF culture. The diagnosis of cryptococcal meningitis was confirmed, and antifungal induction therapy was started with liposomal amphotericin B and flucytosine. After clinical improvement, induction therapy was discontinued, and the patient was discharged under maintenance therapy with fluconazole. While under antifungal maintenance therapy, the patient presented worsening of symptoms and a new brain magnetic resonance showed the development of multiple cryptococcoma. Despite sterile CSF cultures, there was a deterioration of the cytochemical parameters. The diagnosis of immune reconstitution inflammatory syndrome was assumed, and after initiation of corticotherapy, the patient improved considerably. This is a rare case of cryptococcal meningitis in a puerperal woman with a challenging management.

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“…Several cases of pregnant women without AIDS [1][2][3][4] or treated by immunosuppressive drugs for lupus 9 are found in the literature but all had the meningitic form of the disease. Pregnancy may predispose to infections because of adjustments in the immune system in normal women, especially suppression of cell-mediated responses 10 .…”

Section: Case Repor Case Repor Case Repor Case Repor Case Report T T T Tmentioning

confidence: 99%

“…Since the first report in 1936, 23 further cases not associated with acquired immunodeficiency syndrome (AIDS) have been recorded, all of which had the meningitic form [1][2][3][4] . The following case is unique in that the main feature was voluminous intraparenchymatous pseudocysts filled with parasites and leading to severe intracranial hypertension.…”

mentioning

confidence: 99%

Pseudocystic form of neurocryptococcosis in pregnancy: case report

Nucci

Maciel

Queiróz

et al. 1999

Arq. Neuro-Psiquiatr.

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-We report a case of neurocryptococcosis which is unique in the literature because the patient had a pseudocystic form of the disease during pregnancy and without any evidence of AIDS. The clinical picture was that of intracranial hypertension and the epidemiological background was highly suggestive of cysticercosis. CT showed multiple round hypodense lesions in the basal ganglia and cerebellum, without contrast enhancement. Since a scolex was not visible, the diagnosis of neurocysticercosis was considered probable. CSF examination was not performed in view of its high risk. The patient had progressive downhill course. Autopsy disclosed multiple gelatinous pseudocysts in the cerebral and cerebellar gray matter, containing abundant Cryptococcus neoformans. Meningeal involvement was minimal. The child was delivered by caesarean section and was free of infection, but died later of hyaline membrane disease. The neuroimaging appearances of this rare instance of the pseudocystic form of neurocryptococcosis mimicked closely neurocysticercosis and only postmortem examination allowed correct diagnosis. The pseudocystic form has so far only been reported in AIDS.KEY WORDS: neurocryptococcosis, neurocysticercosis, pregnancy, pseudocysts.Neurocriptococose na gravidez: forma pseudocística. Relato de Caso RESUMO -Relatamos o primeiro caso da forma pseudocística da neurocriptococose na gravidez, em paciente sem evidência de AIDS. O quadro clínico era de hipertensão intracraniana que se manifestou no segundo trimestre da gravidez. A tomografia computadorizada do crânio evidenciava múltiplas lesões hipodensas, císticas, não impregnadas por contraste, localizadas na substância cinzenta cerebral e cerebelar. Dados epidemiológicos, clínicos e tomográficos apontavam para o diagnóstico provável de neurocisticercose. A autópsia, porém, revelou múltiplos pseudocistos de material gelatinoso com Cryptococcus neoformans em abundância. Havia mínimo comprometimento meníngeo. A revisão da literatura mostrou que a forma pseudocística da neurocriptococose só foi até o momento relatada em pacientes com AIDS. Os casos de neurocriptococose na gravidez até hoje publicados foram todos da forma meningítica. PALAVRAS -CHAVE: neurocriptococose, neurocisticercose, gravidez, pseudocistos.Neurocryptococcosis is rare in pregnancy. Since the first report in 1936, 23 further cases not associated with acquired immunodeficiency syndrome (AIDS) have been recorded, all of which had the meningitic form [1][2][3][4] . The following case is unique in that the main feature was voluminous intraparenchymatous pseudocysts filled with parasites and leading to severe intracranial hypertension.

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Neurocriptococose durante a gravidez: revisão da literatura. Relato de dois casos

Cited by 11 publications

References 14 publications

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

Cryptococcal Meningitis in an HIV-Negative Puerperal Woman

Pseudocystic form of neurocryptococcosis in pregnancy: case report

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