Corticosteroids for the management of severe intracranial hypertension in meningoencephalitis caused by Cryptococcus gattii: A case report and review.
Immune reconstitution inflammatory syndrome in meningitis caused by Cryptococcus gattii in immunocompetent patients after initiation of antifungal therapy appears to be the result of paradoxical antifungal treatment-induced clinical deterioration due to improved local immune responses to cryptococcal organisms. Recent anecdotal reports have suggested a favorable clinical response to corticosteroids in select patients with C. gattii central nervous system (CNS) infections. In this report, we describe a 65-year-old patient with meningoencephalitis caused by C. gattii who developed persistent intracranial hypertension and was successfully managed with antifungal therapy, repeated lumbar puncture and corticosteroids. Our observations suggest a possible benefit of dexamethasone in the management of select cases of C. gattii CNS infection with intracranial hypertension. Further studies are necessary to evaluate the long-term use of steroids in select patients with C. gattii with intracranial hypertension.
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Maciel
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Ferreira
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Wirth
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Rosa
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Aves
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil.
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Turra
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, 90035-903 Porto Alegre, RS, Brazil. Electronic address: lgoldani@ufrgs.br.
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Goldani
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D056285:Cryptococcus gattii / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000188:drug therapy*; D008590:Meningoencephalitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology
D000305:Adrenal Cortex Hormones
Corticosteroids; Corticoïdes; Cryptococcus gattii; Hypertension intracrânienne; Intracranial hypertension; Management; Traitement