Dados do Trabalho

Título

Neurocryptococcosis and neurosarcoidosis: simultaneous presentation in an immunocompetent patient.

RESUMO

CASE PRESENTATION: C.A.J.S. Male, 52 years, underwent restrictive diet (loss of 20 kilos in 3 months), evolving with depressive symptoms associated with the neurological framework of paraparesia, abasia, astasia, urinary and fecal incontinence, constipation and hypoesthesia in lower limbs, being restricted to the bed. After psychiatric treatment with antidepressants and antipsychotics had improved mood and he returned to wander, but only with support. Then there was sudden worsening of strength and equilibrium, being hospitalized for neurological framework. In lumbar puncture was verified the presence of cryptococcus by the direct research of fungi and performed treatment with antifungal for 42 days, with discreet improvement. Concomitant to the previous findings a chest tomography was performed to evoluate pulmonary compromise by the, being evidenced mediastinal lymph node in which anatomopathological suggested the presence of sarcoidosis, raising the idea of neurosarchoidosis in coexistence with neurocryptococcosis. Subsequently, pulse therapy was instituted with methylprednisolone and the patient presented substantial improvement of symptoms. DISCUSSION: Neurocryptococcosis is a serious and usually fatal infection caused by two species: Cryptococcus neoformans and Cryptococcus gattii. In general, it presents as cryptococcal meningitis and affects immunocompromised individuals, with typical symptoms of meningeal infection: headache, lowered level of consciousness and cerebrospinal fluid changes. Neurosarcoidosis (NS) is a granulomatous disease of unknown etiology, whose main manifestations are leptomeningitis, cranial nerve involvement, hypothalamic dysfunction and intraparenchymal masses, corresponding to 5% of the presentations of sarcoidosis. In the case described above, we have a patient presenting with nonspecific systemic manifestations and significant impairment of sensory and motor functions, in addition to associated psychiatric symptoms, with simultaneous presentation of diseases. FINAL COMMENTS: Neurocryptococcosis is a rare fungal disease in immunocompetent patients. This case stands out for its concomitance with another uncommon disease: neurosarcoidosis, in a previously healthy patient, enabling differential diagnoses of rare combinations with a favorable outcome.