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Título

Cryptococcosis as a cause of parainfectious cerebral vasculitis

RESUMO

Case report: Female, 56 years old, with sudden onset of difficulty opening the left eye associated with diplopia. She reports a history of severe holocranial headache that started 5 days ago. Known comorbidities: Systemic lupus erythematosus and antiphospholipid antibody syndrome, using Marevan 5mg/day and prednisone 10mg/day. Physical examination: paresis of left eye adduction, left eyelid ptosis, nuchal rigidity. Computed tomography of the brain at admission without alterations. Cranial MRI showed an acute ischemic vascular insult in the left midbrain. CSF study revealed: 240 cells (predominance of mononuclear cells); glucose: 13; proteins: 192; Positive China ink; positive latex test for c. neoformans. In view of the diagnosis of neurocryptococcosis, cerebral infarction secondary to parainfectious cryptococcal vasculitis was suspected and therapy was initiated. Discussion:Immunosuppressive conditions increase the risk of CNS infections. CNS vasculitis associated with cryptococcal infection is rare, with clinical manifestations of cerebral infarctions in the internal capsule, thalamus and basal ganglia. The clinical course has a subacute or chronic onset, which can usually lead to delays in diagnosis and adequate treatment. Radiological examinations such as CT and magnetic resonance imaging (MRI) contribute to the visualization of infarcted areas, emphasizing the value of angiography with evidence of vasculitis. The diagnosis is confirmed through confirmation in the cerebrospinal fluid with nanquin ink and culture. Treatment should be instituted as soon as possible, aiming to reduce morbidity and mortality from the disease.
Final Comments: Although rare, it is important to know this presentation in neurocryptococcosis, since early diagnosis and management provide a reduction in patient morbidity and mortality.

Palavras Chave

Cryptococcosis Vasculitis