title: [Clinical problems in medical mycology: Problem number 49].
abstract: The case of a 59-year-old female born in Buenos Aires (Argentina) is presented. She had been diagnosed with HIV in 2007 and received highly active antiretroviral therapy until 2011; she also suffered from diabetes type 2. She had received empirical treatment (pyrimethamine-clindamycin) for cerebral toxoplasmosis. Fifteen days later she suffered a drug-induced skin disorder and was treated in the Dermatology Service of the Hospital Muñiz with corticosteroids. After five weeks she was readmitted to the Infectious Disease Unit due to asthenia, weight loss, left hip pain and weakness in all four limbs. Septic arthritis and aseptic hip necrosis were ruled out. Blood cultures were positive for Staphylococcus aureus and Escherichia coli. The patient received intravenous antibiotics, but before being discharged Acinetobacter baumannii was isolated from blood, catheter and urine cultures, and a new series of antibiotics were prescribed. On the 3rd day she presented encephalic facies, changes of behaviour and disorientation, without nuchal rigidity, Kernig and Brudzinski signs or focal signs. An X-ray computed tomography did not show parenchymal lesions. A yeast identified as Candida albicans was isolated in a cerebrospinal fluid culture. The same yeast was recovered in a new cerebrospinal fluid sample. The isolate was susceptible to amphotericin B and susceptible dose dependent to fluconazole. The patient was treated with amphotericin B (0.7mg/kg plus 800mg fluconazole daily). Three weeks later, new cerebrospinal fluid cultures were negative. Unfortunately, the patient died soon afterwards.
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Negroni
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Roxana
authors.initials: R
authors.lastname: Depardo
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Messina
authors.affiliation: Sala 21, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Julián
authors.initials: J
authors.lastname: García
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina. Electronic address: santisog@hotmail.com.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Santiso
authors.affiliation: Sala 21, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Verónica
authors.initials: V
authors.lastname: Mingrone
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marin
authors.affiliation: Unidad de Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
authors.forename: Alicia
authors.initials: A
authors.lastname: Arechavala
mesh_terms: D002177:Candidiasis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged