Cargando…

A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis

Cryptococcal meningitis is a systemic infection that can be seen in immunosuppressed patients. Altered mental status, somnolence, and obtundation are warning signs of poor prognosis or advanced disease processes. We present a 23-year-old female with a past medical history significant for human immun...

Descripción completa

Detalles Bibliográficos
Autores principales: Loye, Ayomide, Gabriel, Onyinye, Zhang, Xiao Chi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624158/
https://www.ncbi.nlm.nih.gov/pubmed/31312577
http://dx.doi.org/10.7759/cureus.4652
_version_ 1783434213584797696
author Loye, Ayomide
Gabriel, Onyinye
Zhang, Xiao Chi
author_facet Loye, Ayomide
Gabriel, Onyinye
Zhang, Xiao Chi
author_sort Loye, Ayomide
collection PubMed
description Cryptococcal meningitis is a systemic infection that can be seen in immunosuppressed patients. Altered mental status, somnolence, and obtundation are warning signs of poor prognosis or advanced disease processes. We present a 23-year-old female with a past medical history significant for human immunodeficiency virus (HIV) obtained via vertical transmission who presented to the emergency department (ED) with a gradual onset of worsening headache over 10 days, with blurry vision, photophobia, nausea and vomiting, and progressive memory lapses. Her blood tests, chest plain radiograph, and non-contrast brain computed tomography (CT) were normal. In the ED, she developed a fever of 102°F and became more confused and agitated, with interspersed screaming and yelling. A lumbar puncture (LP) showed elevated white blood cell count and was positive for Cryptococcus neoformans; an opening pressure was unable to be obtained due to patient agitation. Despite prompt intravenous antibiotics and antifungal medications, her short, but tenuous hospital course involved declining mental status, requiring intubation and multiple therapeutic lumbar punctures, with an elevated opening pressure of up to 55 cm H2O. The patient suffered global ischemic encephalopathy and died on hospital day two. This case highlights the rapid decompensation of a young immunocompromised patient with cryptococcal meningitis, as well as the importance of early disease management and consultation to neurology and neurosurgery services. An important paradigm difference for emergency medicine (EM) physicians in the management of increased intracranial pressure (ICP) in patients with cryptococcal meningitis is avoiding acetazolamide, mannitol, and steroids and considering the indication for neurosurgical interventions for severe cryptococcal meningitis.
format Online
Article
Text
id pubmed-6624158
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-66241582019-07-16 A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis Loye, Ayomide Gabriel, Onyinye Zhang, Xiao Chi Cureus Emergency Medicine Cryptococcal meningitis is a systemic infection that can be seen in immunosuppressed patients. Altered mental status, somnolence, and obtundation are warning signs of poor prognosis or advanced disease processes. We present a 23-year-old female with a past medical history significant for human immunodeficiency virus (HIV) obtained via vertical transmission who presented to the emergency department (ED) with a gradual onset of worsening headache over 10 days, with blurry vision, photophobia, nausea and vomiting, and progressive memory lapses. Her blood tests, chest plain radiograph, and non-contrast brain computed tomography (CT) were normal. In the ED, she developed a fever of 102°F and became more confused and agitated, with interspersed screaming and yelling. A lumbar puncture (LP) showed elevated white blood cell count and was positive for Cryptococcus neoformans; an opening pressure was unable to be obtained due to patient agitation. Despite prompt intravenous antibiotics and antifungal medications, her short, but tenuous hospital course involved declining mental status, requiring intubation and multiple therapeutic lumbar punctures, with an elevated opening pressure of up to 55 cm H2O. The patient suffered global ischemic encephalopathy and died on hospital day two. This case highlights the rapid decompensation of a young immunocompromised patient with cryptococcal meningitis, as well as the importance of early disease management and consultation to neurology and neurosurgery services. An important paradigm difference for emergency medicine (EM) physicians in the management of increased intracranial pressure (ICP) in patients with cryptococcal meningitis is avoiding acetazolamide, mannitol, and steroids and considering the indication for neurosurgical interventions for severe cryptococcal meningitis. Cureus 2019-05-13 /pmc/articles/PMC6624158/ /pubmed/31312577 http://dx.doi.org/10.7759/cureus.4652 Text en Copyright © 2019, Loye et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Loye, Ayomide
Gabriel, Onyinye
Zhang, Xiao Chi
A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title_full A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title_fullStr A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title_full_unstemmed A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title_short A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis
title_sort case report: tragic death in a young patient with human immunodeficiency virus due to cryptococcal meningitis
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624158/
https://www.ncbi.nlm.nih.gov/pubmed/31312577
http://dx.doi.org/10.7759/cureus.4652
work_keys_str_mv AT loyeayomide acasereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis
AT gabrielonyinye acasereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis
AT zhangxiaochi acasereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis
AT loyeayomide casereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis
AT gabrielonyinye casereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis
AT zhangxiaochi casereporttragicdeathinayoungpatientwithhumanimmunodeficiencyvirusduetocryptococcalmeningitis