Cryptococcus성 뇌수막염 1례

초록

A case of cryptococcal meningitis is reported, which occurred in a 25-year old female whose chief complaints were severe headache, vomiting and double vision lasting one month. Neurological examination on admission (September 7, 1973) showed no significant abnormalities except for the bilateral papilledema and subjective horizontal diplopia. Simple skull and chest films including results of specific diagnostic procedures were grossly intact. Cerebrospinal fluid examination disclosed pleocytosis, increased protein, and decreased sugar and chloride, levels which was the finding compatible with those of tuberculous meningitis etc. The subject was treated under the diagnosis of tuberculous meningitis. Two weeks after the admission, direct smear of the spinal fluid showed numerous yeast like cells, and cryptococcus neoformans was confirmed by India ink preparation and culture in Sabouraud's glucose agar. Amphotericin B was administered by slow intravenous drip over a span of several hours starting with 0.25 mg/kg of body weight and increasing gradually up to 1.25 mg/kg of body weight daily. Clinical improvements of the patient's condition along with disappearance of cryptococcus neoformans in CSF examination were obtained by the treatment with Amphotericin B injection, although a fall in hemoglobin, hypopotassemia, moderate degree of fever and occasional vomiting were observed as side effects during the course of treatment. Cryptococcus is highly fatal infection caused by cryptococcus neoformans which is a special predilections for the central nervous system. Cryptococcosis may also involve the lungs, bones and skin, and occurs with increased frequency in patients with leukemia or lymphomas. This infection is most common in male adult, and the protal entry is the respiratory tract.