Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of successful treatment of brain and lung cryptococcosis caused by Cryptococcus gattii

Kazuhiro Horiuchi, M.D.1), Moemi Yamada, M.D.1), Shinichi Shirai, M.D.1), Ikuko Takahashi, M.D.1), Takahiro Kano, M.D.1), Yukihiro Kaneko, M.D.2), Kouji Akizawa, M.D.3), Takashi Umeyama, M.D.2), Yoshitsugu Miyazaki, M.D.2), Ichiro Yabe, M.D.1) and Hidenao Sasaki, M.D.1)

1)Department of Neurology, Hokkaido University Graduate School of Medicine
2)Department of Chemotherapy and Mycoses, National Institute of Infectious Disease
3)Department of Laboratory and Blood Center, Hokkaido University Hospital

We report the case of a 34-year-old woman with cerebral and pulmonary cryptococcosis. After surgery for uterine cervical cancer, chest CT scan indicated a solitary tumor. Cryptococcosis was detected by transbronchial lung biopsy, and brain MRI showed multiple tumors. We diagnosed the patient with cerebral and pulmonary cryptococcosis. Oral and intravenous antifungal treatments were not effective, and a disturbance of consciousness appeared. We began intraventricular antifungal treatment, and the symptoms improved, with a reduction in the size of multiple lesions. However, the size of the brain lesions increased, and we diagnosed late deterioration of cryptococcosis and corticosteroid response. Because of the refractory clinical course, we examined the Cryptococcus strains from the surgical resected pulmonary lesion and identified Cryptococcus gattii (VG I type). C. gattii occurs predominantly in apparently healthy hosts. An intracranial C. gattii infection is associated with neurological complications and delayed therapeutic response. If cerebral cryptococcosis responds slowly and relatively poorly to antifungal therapy, C. gattii should be considered. Aggressive therapy, including intraventricular therapy and corticosteroids therapy for cryptococcoma, is required.
Full Text of this Article in Japanese PDF (558K)

(CLINICA NEUROL, 52: 166|171, 2012)
key words: Cryptococcus infection, Intraventricular therapy, cryptococcoma, Cryptococcus gattii

(Received: 7-Sep-11)