title: [A case of successful treatment of brain and lung cryptococcosis caused by Cryptococcus gattii].
abstract: We report the case of a 34-year-old woman with cerebral and pulmonary cryptococcosis. After surgery for uterine cervical cancer, chest CT scan indicated a solitary tumor. Cryptococcosis was detected by transbronchial lung biopsy, and brain MRI showed multiple tumors. We diagnosed the patient with cerebral and pulmonary cryptococcosis. Oral and intravenous antifungal treatments were not effective, and a disturbance of consciousness appeared. We began intraventricular antifungal treatment, and the symptoms improved, with a reduction in the size of multiple lesions. However, the size of the brain lesions increased, and we diagnosed late deterioration of cryptococcosis and corticosteroid response. Because of the refractory clinical course, we examined the Cryptococcus strains from the surgical resected pulmonary lesion and identified Cryptococcus gattii(VG I type). C. gattii occurs predominantly in apparently healthy hosts. An intracranial C. gattii infection is associated with neurological complications and delayed therapeutic response. If cerebral cryptococcosis responds slowly and relatively poorly to antifungal therapy, C. gattii should be considered. Aggressive therapy, including intraventricular therapy and corticosteroids therapy for cryptococcoma, is required.
authors.affiliation: Department of Neurology, Hokkaido University Graduate School of Medicine.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Horiuchi
authors.forename: Moemi
authors.initials: M
authors.lastname: Yamada
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Ikuko
authors.initials: I
authors.lastname: Takahashi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kano
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Kouji
authors.initials: K
authors.lastname: Akizawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Umeyama
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yabe
authors.forename: Hidenao
authors.initials: H
authors.lastname: Sasaki
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D003453:Cryptococcosis / Q000188:drug therapy* / Q000382:microbiology*; D056285:Cryptococcus gattii / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000382:microbiology*; D016919:Meningitis, Cryptococcal / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D000666:Amphotericin B