Cryptococcus gattii meningitis developed after pneumonectomy in a case of necrotizing pneumonia
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
25
Journal Issue
1
Pages
30-35
Date Issued
2014
Author(s)
Abstract
Cryptococcus gattii infection has rarely been reported in Taiwan. We report a case of 32-year-old immunocompetent male Vietnamese referred for pneumonectomy under the impression of necrotizing pneumonia. Pleural effusion was collected during the pneumonectomy and the culture of pleural effusion yielded Cryptococcus. Although oral fluconazole 200 mg daily was prescribed, meningitis developed 10 days after pneumonectomy. Culture of cerebrospinal fluid (CSF) yielded Cryptococcus. The patient received amphotericin B plus flucytosine for two weeks as antifungal induction therapy, followed by intravenous fluconazole 400 mg per day as consolidation therapy. The molecular typing of Cryptococcus was C. gattii V Gll. He was discharged on the 40 th day after admission and was prescribed oral fluconazole 200 mg daily for 110 days at outpatient department. No neurological sequela was found at the time of last follow-up. Importantly, Cryptococcus has tendency to infect the central nervous system (CNS), especially the subspecies C. gattii, which could be differentiated from C. neoformans by its activity in the medium containing canavanine, glycine and bromothymol blue (CGB). Patients with necrotizing pneumonia caused by C. gattii should be treated as central nervous system infection. In conclusion, appropriate fungicidal agents to cover CNS infection should be administered for this kind of patient from the time of first disease onset.
Subjects
Cryptococcus; Cryptococcus gattii; Meningitis; Necrotizing pneumonia
SDGs
Other Subjects
amoxicillin plus clavulanic acid; amphotericin B; antibiotic agent; fluconazole; flucytosine; levofloxacin; piperacillin plus tazobactam; roxythromycin; unclassified drug; adult; antibiotic therapy; antifungal susceptibility; article; bacterial meningitis; case report; cerebrospinal fluid analysis; computer assisted tomography; cryptococcal meningitis; Cryptococcus gattii; Cryptococcus gattii meningitis; drug substitution; drug withdrawal; follow up; human; lumbar puncture; lung resection; male; necrotizing pneumonia; outpatient care; pleura effusion; pneumonia; thorax radiography
Publisher
Society of Internal Medicine of Taiwan
Type
journal article