Cryptococcal Meningitis: Report of a Case

Araj, George F.; Musharafieh, Umaya M.; Mughnieh, Rima A.; Uwaydah, Marwan

doi:10.5144/0256-4947.1994.247

Cited by 3 publications

(2 citation statements)

References 23 publications

(31 reference statements)

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“…Cryptococcal meningitis has rarely been reported from our region. 13 Our patient is the first case of cryptococcal meningitis complicated by bilateral visual loss reported from this region. He had combined pulmonary and meningeal cryptococcosis.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Visual Loss Due to Cryptococcal Meningitis

Soub

1996

Ann Saudi Med

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H Al Soub, Bilateral Visual Loss Due to Cryptococcal Meningitis. 1996; 16(1): 84-86 Cryptococcal meningitis is the most common central nervous system infection in the immunosuppressed. 1 Survivors of cryptococcal meningitis are often left with several permanent neurologic sequelae; among these is bilateral visual loss.2 Intracranial hypertension plays an important role in the pathogenesis of this complication. 3Several studies have demonstrated that the prognosis is dependent on early diagnosis and administration of appropriate therapy. 3,4 Approximately 60 cases of cryptococcal meningitis-associated visual loss have been reported previously, either as case reports or in a small series. [4][5][6] The following is the description of a case of cryptococcal meningitis that was complicated by severe visual loss in a patient with acquired immunodeficiency syndrome (AIDS). The pertinent literature is also reviewed. Case ReportA 20-year-old Qatari male, known to have hemophilia A and AIDS, was admitted to Hamad General Hospital in August 1994 with complaints of painful swelling of three days' duration in both forearms, and cough and sputum production of one month's duration. Examination revealed a temperature of 39°C, blood pressure 110/60 mmHg, respiratory rate 28/minute, pulse rate 122/minute, oral thrush, dullness and crepitations in the right lung base, and hematomas in both forearms. Otherwise, the physical examination was unremarkable.Laboratory investigations revealed a hemoglobin of 11.1 g/dL, white blood cell count (WBC) 3.6x10 3 /L. and platelets 59x10 3 /L. Chest x-ray showed consolidation in the right lower lobe with cavitation and right pleural effusion (Figure 1). CD4+ lymphocyte count was 12/mm 3 . Blood culture and sputum for acid-fast bacilli smear and fungal culture were negative. Pleural aspiration and biopsy were refused by the patient. He was treated with factor eight concentrate transfusion, intravenous erythromycin and trimethoprim/sulfamethoxasole. Hematomas resolved gradually and he became afebrile. Repeat chest x-ray on the 9th hospital day revealed significant reduction of the right pleural effusion. The patient insisted on going home, so he was discharged on the 10th hospital day. Two weeks later he was readmitted with complaints of fever, occipital headache, and vomiting of three days' duration. Examination revealed blood pressure of 110/70 mmHg, temperature 36.6°C, pulse rate 60/minute, oral thrush, markedly tender neck muscles, but no neck stiffness. There were crepitations in the right lung base. Otherwise, the examination was unremarkable.Laboratory investigations revealed a normal computed tomographic (CT) scan of the head, negative tuberculin skin test, and a chest x-ray which showed further reduction in the right pleural effusion and consolidation (Figure 2). On the 5th hospital day, the patient developed tonic clonic convulsions, so a magnetic resonance imaging (MRI) scan of the head was done and was found to be normal. Lumbar puncture was refused by the patient and his family. O...

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Section: Discussionmentioning

confidence: 99%

Bilateral Visual Loss Due to Cryptococcal Meningitis

Soub

1996

Ann Saudi Med

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“…CSF acid‐fact bacilli smear was negative. Cryptococcal and other fungal meningitis could also be considered in this patient. A case report was published from Lebanon of cryptococcal meningitis in an immunocompromised patient, which is the setting where this type of meningitis is seen [4]. However, the present patient is immunocompetent, and dimorphic fungal infections are not endemic in Lebanon, thus making fungal meningitis a less likely diagnosis.…”

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confidence: 89%

Clinical microbiological case: a previously healthy woman presenting with headache and diplopia

Mooty¹,

Kanj²,

Araj³

et al. 2001

Clinical Microbiology and Infection

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Clinical microbiological case: a previously healthy woman presenting with headache and diplopia

Mooty

Kanj

Araj³

et al. 2001

Clinical Microbiology and Infection

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Medical Center (AUBMC) with a 9-month history of diplopia and headache. She described the headache as diffuse, with one to two attacks per week, lasting all day, responding to paracetamol, and associated occasionally with nausea and vomiting. She reported anorexia and weight loss of 10 kg during this period. The patient denied any history of fever or chills. She lives in the southern part of Lebanon but had previously lived for 10 years in the United Arab Emirates. Prior to her referral to the AUBMC, the patient was treated with alprazolam and valproic acid for 5 months for suspected anxiety and migraine. On examination, she was afebrile, with normal vital signs. The cardiovascular, pulmonary and abdominal examinations were all normal. Neurologic examination revealed the absence of neck stiffness, or sensory or motor deficits. She had normal cerebellar signs. Fundoscopic examination showed no evidence of increased intracranial pressure. Cranial nerve examination showed a left lateral rectus palsy. MRI scans of brain and orbit were normal. A diagnostic test was ordered. QUE S T ION S1. What is the differential etiologic diagnosis? 2. Which diagnostic tests would you order? 3. What is your syndromic and etiologic diagnosis?

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Cryptococcal Meningitis: Report of a Case

Cited by 3 publications

References 23 publications

Bilateral Visual Loss Due to Cryptococcal Meningitis

Bilateral Visual Loss Due to Cryptococcal Meningitis

Clinical microbiological case: a previously healthy woman presenting with headache and diplopia

Clinical microbiological case: a previously healthy woman presenting with headache and diplopia

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