title: Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report.
abstract: 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.
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
authors.forename: José Edward
authors.initials: JE
authors.lastname: Hagan
authors.affiliation: Hospital Couto Maia, Secretaria de Saúde do Estado da Bahia, Salvador, BA, Brasil.
authors.forename: Jesângeli Sousa
authors.initials: JS
authors.lastname: Dias
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brasil.
authors.forename: José Caetano
authors.initials: JC
authors.lastname: Villasboas-Bisneto
authors.affiliation: Hospital Couto Maia, Secretaria de Saúde do Estado da Bahia, Salvador, BA, Brasil.
authors.forename: Melissa Barreto
authors.initials: MB
authors.lastname: Falcão
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Albert Icksang
authors.initials: AI
authors.lastname: Ko
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, Brasil.
authors.forename: Guilherme Sousa
authors.initials: GS
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy*; D011645:Puerperal Infection / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole