| Journal: | Revista do Instituto de Medicina Tropical de Sao Paulo |
| Database: | PERIÓDICA |
| System number: | 000385673 |
| ISSN: | 0036-4665 |
| Authors: | Daher, Elizabeth de Francesco1 Nasserala, Jarinne Camilo Landim1 Silva-Junior, Geraldo Bezerra da2 Oliveira, Adriana Regina Vilarinho de3 Medeiros-Neto, Jose Urbano de3 Sousa, Anastacio Queiroz3 |
| Institutions: | 1Universidade Federal do Ceara, Hospital Universitario Walter Cantidio, Fortaleza, Ceara. Brasil 2Universidade de Fortaleza, Faculdade de Medicina, Fortaleza, Ceara. Brasil 3Universidade Federal do Ceara, Faculdade de Medicina, Fortaleza, Ceara. Brasil |
| Year: | 2015 |
| Season: | Jul-Ago |
| Volumen: | 57 |
| Number: | 4 |
| Pages: | 365-367 |
| Country: | Brasil |
| Language: | Inglés |
| Document type: | Artículo |
| Approach: | Caso clínico |
| English abstract | The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality |
| Portuguese abstract | Apresentamos um caso fatal de criptococose disseminada em homem jovem cujo diagnóstico de HIV foi feito no momento da admissão na emergência. Relato de caso: O paciente, de 23 anos, sexo masculino, tinha história de febre diária de um mês de duração, associada à diarreia, perda de peso, cefaleia, vômitos e convulsões generalizadas. Tinha ainda história de diabetes mellitus, alcoolismo e drogadição. Ao exame físico havia palidez, desorientação e períodos de agitação. Os exames laboratoriais mostraram 3.440 leucócitos/mm3 (5% linfócitos), hemoglobina de 10 g/dL, 83,000 plaquetas/mm3, creatinina de 0,7mg/dL, ureia de 19 mg/dL, Na, K e enzimas hepáticas dentro dos limites da normalidade. A lactato desidrogenase era 494 UI/L. Análise do líquor revelou 10 leucócitos/mm3 (58% neutrófilos, 31% linfócitos, 11% monócitos) e 2 hemácias/mm3, glicose de 122 mg/dL e proteína de 36 mg/dL. A análise com tinta da Índia revelou seis blastoconídeos de Cryptococcus/mm³. O VDRL foi negativo e o anti-HIV positivo. Foi iniciado tratamento com hidratação venosa, insulina, fenitoína, fluconazol, pirimetamina, sulfadiazina, ácido folínico e anfotericina B. O paciente não apresentou melhora e evoluiu com obnubilação e hipotensão, sendo intubado e iniciada ventilação mecânica. Foram administradas drogas vasoativas, e o paciente evoluiu a óbito menos de 24h após a admissão. A autópsia revelou criptococose disseminada, com grave envolvimento renal. Conclusão: A criptococose é via-de-regra, doença sistêmica que afeta principalmente indivíduos imunocomprometidos, especialmente com AIDS, e quando diagnosticada tardiamente apresenta alta mortalidade |
| Disciplines: | Medicina |
| Keyword: | Diagnóstico, Microbiología, Cryptococcus, VIH, Síndrome de inmunodeficiencia adquirida (SIDA), Criptococosis, Mortalidad, Insuficiencia renal aguda (IRA) |
| Keyword: | Medicine, Diagnosis, Microbiology, Cryptococcus, HIV, Acquired immunodeficiency syndrome (AIDS), Cryptococcosis, Mortality, Acute renal failure (ARF) |
| Full text: | Texto completo (Ver HTML) |
