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

Rev Soc Bras Med Trop. 2014 Mar-Apr;47(2):254-6. doi: 10.1590/0037-8682-0215-2013.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • Female
  • Fluconazole / therapeutic use*
  • Humans
  • Magnetic Resonance Imaging
  • Meningitis, Cryptococcal / diagnosis
  • Meningitis, Cryptococcal / drug therapy*
  • Puerperal Infection / diagnosis
  • Puerperal Infection / drug therapy*

Substances

  • Antifungal Agents
  • Fluconazole