AI Summary & Key Takeaways
AI InsightEspecially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is
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Abstract
In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement. A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection. Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results. India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells. Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture. Liposomal amphotericin B and fluconazol was added to the treatment schedule. Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement. Antifungal therapy was continued as oral fluconazole after 40 days. Fluconazol was discontinued when CD4+ T cell count increased over 100/mm3 after 12 months. The patient had persistently elevated creatinin levels under ART without antifungal therapy. Last creatinine value was 2.4 mg/dL after a one-year follow-up. Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is
Özet
Bu yazıda, akut başlangıçlı ve çoklu organ tutulumlu bir Cryptococcusneoformans menenjiti olgusu sunuldu. 44 yaşında erkekhasta, HIV infeksiyonu tanısıyla antiretroviral tedavi (ART)başlandıktan bir ay sonra bulantı, kusma, baş ağrısı ve geneldurumunda bozulma şikayetleriyle yatırıldı. Klinik bulgular veinceleme sonuçlarıyla pnömoni, retinit ve menenjit saptananhastaya ampirik antibiyotik tedavisi başlandı. Beyin-omuriliksıvısı (BOS)’nın çini mürekkebi preparatında tomurcuklanmışkapsüllü maya hücreleri görüldü. BOS’ta kriptokok antijenipozitifti ve BOS kültüründe C. neoformans üredi. Hastanın tedavisinelipozomal amfoterisin B ve flukonazol eklendi. Renalbiyopsiyle alınan böbrek dokusunun histopatolojik incelemesindeyaygın parenkimal kriptokokok tutulumu saptandı. Antifungaltedavi 40. günden sonra oral flukonazolle sürdürüldü.12 ay sonra CD4+ T hücresi sayısı 100/mm3’ün üstüne çıkıncaflukonazol kesildi. ART altında ve antifungal tedavi almaksızınizlenen hastanın yüksek kreatinin düzeyleri devam etti. Bir yıllıkizlemin ardından son kreatinin değeri 2.4 mg/dl idi. Özellikleyeni tanı almış HIV-pozitif olgularda CD4+ T hücresi sayısı