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Título

Fungal brain abscess as a differential diagnosis of neuroinfection in immunocompetetens patients

RESUMO

Case report: Patient in 56 years old, hypertensive, presented changes cognitive and behavioral, followed by progressive impairment of the level of consciousness with a gradual evolution in 3 weeks, associated with fever, deficits neurological focal and march slowed down. At admission, appeared lethargic, ECG 10, no abnormalities in the examination of the cranial nerves and with motor deficit on the left and without stiffness in back of neck. The Cranial nuclear magnetic resonance (MRI) showed multiple lesions dispersed in the brain parenchyma, more evident in the nucleocapsular, with annular enhancement after intravenous infusion of the contrast, associate The edema vasogenic of parenchyma brain adjacent, and restriction of peripheral diffusion the lesions, presenting a discrete amount of exudative material in the occipital horns of the lateral ventricles, suggestive of of ventriculitis. Treatment was started for bacterial coverage initially with ceftriaxone and Oxacillin, then in Meropenem and vancomycin, for the suspected brain abscess. The liquor collection not performed due to injuries with edema cerebral and Detour in line average. THE investigation for HIV and immunosuppression were negative. Despite antibacterial therapy, patient remained with clinical and laboratory tests worsening, and it was decided to start in therapy with amphotericin B thinking in abscess fungal, although gives renal dysfunction presented by amphotericin B, patient evolved with improvement of the clinic status, being discharged from the intensive care unit. At hospital discharge, the patient is alert, no language deficit, no motor deficit, mild gait slowing, without stiffness. Control cranial MRI examination after hospital discharge evidence decrease of edema and of injuries presented.

Discussion: Fungal brain abscess is a life-threatening condition, more common in immunocompromised individuals, but with increasing reports in the literature in immunocompetent patients. This case highlights the importance and need for a higher level of suspicion and sensitive diagnostic methods to optimize therapy and improve case outcomes.

Comments Finals: Despite of limitations of service for realization of liquor analysis, the importance of evaluating images that suggest fungal abscess were important for outcome positive of case.

Palavras Chave

Neuroinfection; Fungal Abscess; Immunocompetent; Antifungal Therapy

Área

Neuroinfecção