Cargando…

Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique

Immune deficiency is usually the underlying predisposing factor for cryptococcal meningitis, though there have been case reports of immunocompetent patients presenting with same. The portal of entry for Cryptococcus neoformans is the respiratory tract, and by hematogenous spread, it causes systemic...

Descripción completa

Detalles Bibliográficos
Autores principales: Chime, Chukwunonso, Ishak, Charbel, Kumar, Kishore, Kamal, Muhammad, Krishna, Srinivasan, Kelly, Paul, Chilimuri, Sridhar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402215/
https://www.ncbi.nlm.nih.gov/pubmed/30915245
http://dx.doi.org/10.1155/2019/3510860
_version_ 1783400351751208960
author Chime, Chukwunonso
Ishak, Charbel
Kumar, Kishore
Kamal, Muhammad
Krishna, Srinivasan
Kelly, Paul
Chilimuri, Sridhar
author_facet Chime, Chukwunonso
Ishak, Charbel
Kumar, Kishore
Kamal, Muhammad
Krishna, Srinivasan
Kelly, Paul
Chilimuri, Sridhar
author_sort Chime, Chukwunonso
collection PubMed
description Immune deficiency is usually the underlying predisposing factor for cryptococcal meningitis, though there have been case reports of immunocompetent patients presenting with same. The portal of entry for Cryptococcus neoformans is the respiratory tract, and by hematogenous spread, it causes systemic symptoms. The presence of CSF leak is described to have predisposed our immunocompetent patient to infection by this organism possibly through direct spread. The gold standard for diagnosing CSF leak is by cisternography. In this case, we added a technique where nasal gauze is inserted during the procedure and scanned afterwards for dye, thus increasing the confidence of diagnosis of CSF leak through the nares. Prompt diagnosis and treatment is key to prevent adverse outcomes, and we propose that in patients with cryptococcal meningitis without any identifiable risk factor, evaluation for CSF leak should be considered especially with history of head trauma.
format Online
Article
Text
id pubmed-6402215
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-64022152019-03-26 Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique Chime, Chukwunonso Ishak, Charbel Kumar, Kishore Kamal, Muhammad Krishna, Srinivasan Kelly, Paul Chilimuri, Sridhar Case Rep Infect Dis Case Report Immune deficiency is usually the underlying predisposing factor for cryptococcal meningitis, though there have been case reports of immunocompetent patients presenting with same. The portal of entry for Cryptococcus neoformans is the respiratory tract, and by hematogenous spread, it causes systemic symptoms. The presence of CSF leak is described to have predisposed our immunocompetent patient to infection by this organism possibly through direct spread. The gold standard for diagnosing CSF leak is by cisternography. In this case, we added a technique where nasal gauze is inserted during the procedure and scanned afterwards for dye, thus increasing the confidence of diagnosis of CSF leak through the nares. Prompt diagnosis and treatment is key to prevent adverse outcomes, and we propose that in patients with cryptococcal meningitis without any identifiable risk factor, evaluation for CSF leak should be considered especially with history of head trauma. Hindawi 2019-02-20 /pmc/articles/PMC6402215/ /pubmed/30915245 http://dx.doi.org/10.1155/2019/3510860 Text en Copyright © 2019 Chukwunonso Chime et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Chime, Chukwunonso
Ishak, Charbel
Kumar, Kishore
Kamal, Muhammad
Krishna, Srinivasan
Kelly, Paul
Chilimuri, Sridhar
Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title_full Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title_fullStr Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title_full_unstemmed Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title_short Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique
title_sort cryptococcal meningitis in a hiv seronegative patient: a rare complication of cerebrospinal fluid leak detected with a new cisternographic technique
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402215/
https://www.ncbi.nlm.nih.gov/pubmed/30915245
http://dx.doi.org/10.1155/2019/3510860
work_keys_str_mv AT chimechukwunonso cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT ishakcharbel cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT kumarkishore cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT kamalmuhammad cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT krishnasrinivasan cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT kellypaul cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique
AT chilimurisridhar cryptococcalmeningitisinahivseronegativepatientararecomplicationofcerebrospinalfluidleakdetectedwithanewcisternographictechnique