We report the case of a 63-year-old man who initially presented with hearing loss and optic neuritis. He subsequently developed vertigo, and multiple multitopographic cerebral infarctions were documented, with negative vascular risk factor evaluation. Panangiography revealed findings suggestive of central nervous system vasculitis, and the initial lumbar puncture showed no evidence of infection; therefore, an immune-mediated vasculitis was considered. Following further neurological deterioration, central nervous system infection due to Cryptococcus neoformans was confirmed. This case highlights the diagnostic challenge and the limitations of initial microbiological testing in central nervous system cryptococcosis.
Vasculitis del sistema nervioso central
Criptococosis con Vasculitis del Sistema Nervioso Central Mediada Inmunológicamente: Un Reto Diagnóstico. Cryptococcosis with Immune-Mediated Central Nervous System Vasculitis: A Diagnostic Challenge
Palabras clave: Criptococosis,
efecto prozona,
Síndrome de Cogan,
Vasculitis del sistema nervioso central,
Accidente cerebrovascular en un paciente con meningitis por Streptococcus Constellatus. Stroke in a patient with Streptococcus Constellatus meningitis.
Streptococcus Constellatus ssp pharingi belongs to the group of Streptococcus Anginosus, it constitutes normal flora of th respiratory, gastrointestinal and genitourinary tracts, it infrequently produces localized or disseminated infections in patients with risk factors. The case of a 41-year-old male patient is reported, with a history of pituitary macroadenoma resection in 2003, undergoing treatment, who consulted the emergency department for 4 days with intense holocranial headache, fever, emesis, associated with temporospatial disorientation and weakness in lower limbs in the last 24 hours. He required management in the intensive care unit, mechanical ventilation, vasopressor support, and tracheostomy, due to respiratory and hemodynamic deterioration. In extension studies, meningitis due to Streptococcus Constellatus ssp pharingi was documented in the presence of sinusitis, cerebrospinal fluid fistula and multi-infarct cerebral vascular compromise, product of vasculitis of infectious origin, a severe manifestation of
bacterial meningitis, not previously reported by this microorganism.
