Meningoencefalitis criptocóccica refractaria en una mujer joven
Palabras clave:
meningoencefalitis, meningitis criptocócica, paracoccidioidomicosis, inmunodeficiencia variable común, candidiasis vulvovaginal
Resumen
Mujer de 23 años presenta hace 2 meses cefalea que se acompaña de visión borrosa, disartria y pérdida de la conciencia. Por líquido cefalorraquídeo se confirma meningitis a criptococo. A pesar del tratamiento con anfotericina B y fluconazol presenta empeoramiento general. Durante su evolución presentó paracoccidioidomicosis pulmonar y candidiasis vaginal. A pesar de la terapia dirigida, la paciente fallece con la tardía confirmación de una inmunodeficiencia variable común.
Citas
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2. Pappas PG. Cryptococcal infections in non-hiv-infected patients. Trans Am Clin Climatol Assoc. 2013; 124:61-79.
3. Lee YC, Wang JT, Sun HY, Chen YC. Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection. J Microbiol Immunol Infect. 2011; 44(5):338-45.
4. Day JN, Chau TT, Wolbers M, Mai PP, Dung NT, Mai NH, et al. Combination antifungal therapy for cryptococcal meningitis. N Engl J Med. 2013; 368(14):1291-302.
5. Nakajima H, Takayama A, Fujiki Y, Ito T, Kitaoka H. Refractory cryptococcus neoformans meningoencephalitis in an immunocompetent patient: Paradoxical antifungal therapy-induced clinical deterioration related to an immune response to cryptococcal organisms. Case Rep Neurol. 2015; 7(3):204–8.
6. Dutra A, Pereira A, Mendonça M, Nunes AC, da Silva F, Pereira M, et al. Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract. Rev Iberoam Micol. 2017;34(3):180–4.
7. Dropulic LK, Cohen JI. Severe viral infections and primary immunodeficiencies. Clin Infect Dis. 2011; 53(9):897–909.
8. Jiang S. Immunity against fungal infections. Immunol Immunogenet Insights. 2016; 8:3–6.
9. Li R, Rezk A, Li H, Gommerman JL, Prat A, Bar-Or A. Antibody independent function of human B cells contributes to antifungal T cell responses. J Immunol. 2017; 198(8):3245-54.
10. Dufaud C, Rivera J, Rohatgi S, Pirofski LA. Naïve B cells reduce fungal dissemination in cryptococcus neoformans infected Rag1-/- mice. Virulence. 2018; 9(1):173-84.
