Puerperal brain cryptococcoma in an HIV-negative woman successfully treated with fluconazole: a case report

• Published in: Revista da Sociedade Brasileira de Medicina Tropical
• Main Authors: José Edward Hagan, Jesângeli Sousa Dias, José Caetano Villasboas-Bisneto, Melissa Barreto Falcão, Albert Icksang Ko, Guilherme Sousa Ribeiro
• Format: Article in Journal/Newspaper
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2014
• Subjects: Cryptococcus; Immune reconstitution inflammatory syndrome; Treatment; Arctic medicine. Tropical medicine; RC955-962; Arctic
• Online Access: https://doi.org/10.1590/0037-8682-0215-2013; https://doaj.org/article/00de26e77d7440869a760da08930125a

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.