Cryptococcus gattii meningitis in an immunocompromised patient in a hospital in the Peruvian Amazon: case report

Abstract

We report a case of Cryptococcus gattii meningitis in a patient with HIV in the Peruvian Amazon. A 36-year-old male patient with severe neurological symptoms that was diagnosed by cerebrospinal fluid culture. Although liposomal amphotericin B and flucytosine are considered the standard antifungal therapy, due to a lack of resources, an alternative treatment of amphotericin B deoxycholate and fluconazole was used. Even with this alternative, treatment faced challenges due to the persistence of the microorganism. This case highlights the importance of considering C. gattii in the differential diagnosis of cryptococcal meningitis in immunocompromised patients, even in areas where the prevalence of this pathogen is low. The effectiveness of treatment and the patient's survival underscore the need for diagnostic and therapeutic strategies adapted to resource-limited settings.

Figure 1. Timeline. *AmBd: Amphotericin B deoxycholate.

Figure 2. Non-contrast brain CT scan. Axial (A) and sagittal (B) views show a rounded, hypodense image with liquid density located in the midline of the posterior fossa, suggesting an arachnoid cyst. The rest of the brain parenchyma appears normal.

Figura 1. Línea de tiempo. *AmBd: Anfotericina B deoxicolato

Figura 2. Tomografía cerebral sin contraste. A Cortes axial y B) sagital muestran una imagen redondeada e hipodensa, de densidad líquida, localizada en la línea media de la fosa posterior, sugiriendo un quiste aracnoideo. El resto del parénquima cerebral presenta características normales.