Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

• Autor(a) principal: Hagan,José Edward
• Data de Publicação: 2014
• Outros Autores: Dias,Jesângeli Sousa, Villasboas-Bisneto,José Caetano, Falcão,Melissa Barreto, Ko,Albert Icksang, Ribeiro,Guilherme Sousa
• Tipo de documento: Relatório
• Idioma: eng
• Título da fonte: Revista da Sociedade Brasileira de Medicina Tropical
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822014000200254
• topic: Cryptococcus; Immune reconstitution inflammatory syndrome; Treatment

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.