Miguel Genebat1, María J Mayorga-Buiza2, Esperanza Castillo-Ojeda3, Mónica Rivero-Garvía4, Francisco J Márquez-Rivas4, Manuel E Jiménez-Mejías5. 1. Emergency Department, Virgen del Rocío University Hospital, Seville, Spain; Immunovirology Laboratory, Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain. 2. Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain. 3. University of Seville/Spanish National Research Council, Seville, Spain. 4. Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain. 5. Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen del Rocío University Hospital, Seville, Spain; University of Seville/Spanish National Research Council, Seville, Spain. Electronic address: mej-mejias@telefonica.net.
Abstract
BACKGROUND: Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging. CASE DESCRIPTION: A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required. CONCLUSIONS: This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.
BACKGROUND:Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging. CASE DESCRIPTION: A cryptococcal VPS infection occurred in a human immunodeficiency virus-infectedpatient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required. CONCLUSIONS: This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.
Authors: Adriana A Almeida-Apolonio; Wellinton J Cupozak-Pinheiro; Vagner M Berres; Fabiana G S Dantas; Terezinha I E Svidzinski; Kelly M P Oliveira; Marilene R Chang Journal: ScientificWorldJournal Date: 2018-06-06