FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT

Authors

  • Elizabeth De Francesco DAHER Federal University of Ceara; Faculty of Medicine
  • Jarinne Camilo Landim NASSERALA Federal University of Ceara; Hospital Universitário Walter Cantídio
  • Geraldo Bezerra da SILVA JUNIOR University of Fortaleza; School of Medicine
  • Adriana Regina Vilarinho de OLIVEIRA Federal University of Ceara; Faculty of Medicine; Department of Pathology
  • José Urbano de MEDEIROS NETO Federal University of Ceara; Faculty of Medicine; Department of Pathology
  • Anastácio Queiroz SOUSA Federal University of Ceara; Faculty of Medicine

Abstract

Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room.Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcusyeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys.Conclusion:Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

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Published

2015-08-01

How to Cite

DAHER, E. D. F., NASSERALA, J. C. L., SILVA JUNIOR, G. B. da, OLIVEIRA, A. R. V. de, MEDEIROS NETO, J. U. de, & SOUSA, A. Q. (2015). FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT. Revista Do Instituto De Medicina Tropical De São Paulo, 57(4), 365-367. Retrieved from https://www.revistas.usp.br/rimtsp/article/view/105554

Issue

Section

Case Report