Author(s): Hagan,José Edward ; Dias,Jesângeli Sousa ; Villasboas-Bisneto,José Caetano ; Falcão,Melissa Barreto ; Ko,Albert Icksang ; Ribeiro,Guilherme Sousa
Date: 2014
Origin: Oasisbr
Subject(s): Cryptococcus; Immune reconstitution inflammatory syndrome; Treatment
Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.
