隐球菌性脑膜炎的罕见临床表现:详细病史和体格检查的重要性

IF 1 Q4 INFECTIOUS DISEASES
IDCases Pub Date : 2025-01-01 DOI:10.1016/j.idcr.2025.e02311
Shay Nakahira , Marcus Yamamoto , Terry Wood
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引用次数: 0

摘要

隐球菌性脑膜炎是一种严重的真菌感染,可表现为高度可变的神经-眼部和全身症状。虽然它通常与免疫功能低下的个体有关,但越来越多地报道在免疫功能正常的宿主中。新生隐球菌通常与免疫抑制人群中的机会性感染有关,而加蒂隐球菌更常影响免疫正常的个体。观察1例40岁健康女性,新发复发性头痛。在做了一次正常的核磁共振检查后,多名医生给了她安慰,并假定诊断为应激性偏头痛,因为她最近经历了丈夫的突然意外死亡。持续性和进行性头痛、聚焦困难和极度光敏性促使她寻求眼科医生的进一步评估,根据她的腰椎穿刺结果,眼科医生诊断她患有隐球菌脑膜炎。讨论及重要性:尽管最初的临床表现显示为偏头痛,但患者在最初症状出现一个月后最终被诊断为隐球菌性脑膜炎,病情迅速发展为紧急情况,最终导致两次住院,接受了多次脊髓液引流、抗真菌药物治疗和腰椎分流术。本病例强调了全面的病史记录、临床警惕和在任何患者的检查中保持广泛的鉴别诊断的重要性。在这种情况下,眼部症状是免疫功能正常的患者隐球菌脑膜炎的早期表现,突出了在临床实践中需要提高认识,以确保及时诊断和适当管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An unusual clinical presentation of Cryptococcal meningitis: The importance of a detailed history and physical

Purpose

Cryptococcal meningitis is a severe fungal infection that can present with a highly variable range of neuro-ophthalmic and systemic symptoms. Although more classically associated with immunocompromised individuals, it has increasingly been reported in immunocompetent hosts. Cryptococcus neoformans is typically linked to opportunistic infections in immunosuppressed populations, whereas Cryptococcus gattii more commonly affects immunocompetent individuals.

Observations

A healthy 40-year-old female presented with new onset recurrent headaches. After a normal MRI, she was re-assured by multiple physicians and given a presumptive diagnosis of stress induced migraine, as she had recently experienced the sudden unexpected death of her husband. Persistent and progressive headaches, focusing difficulties, and extreme photosensitivity prompted her to seek further evaluation by an ophthalmologist, who diagnosed her with Cryptococcal meningitis based on her lumbar puncture results.

Discussion and importance

Despite the initial clinical impression being suggestive of migraines, the patient was ultimately diagnosed with cryptococcal meningitis one month from the initial onset of her symptoms, with rapid advancement to an emergent situation ultimately resulting in two hospitalizations where she received numerous spinal fluid drainages, anti-fungal medications and a lumbar shunt. This case underscores the importance of comprehensive history-taking, clinical vigilance, and maintaining a broad differential diagnosis in the workup of any patient. Ocular symptoms, in this instance, served as an early manifestation of cryptococcal meningitis in an immunocompetent patient, highlighting the need for heightened awareness in clinical practice to ensure timely diagnosis and appropriate management.
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来源期刊
IDCases
IDCases INFECTIOUS DISEASES-
CiteScore
2.60
自引率
6.70%
发文量
300
审稿时长
10 weeks
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