engleski

Sudden death by cryptococcal meningoencephalitis (CME)

Aim of this article is to present a case report of a cryptococcal meningoencephalitis (CME) with a short survival period. This form of meningoencephalitis (ME) is extremely rare in our hospital. A 53-year old patient was hospitalised in intensive care of the Internal clinic in emergency service due to febrility of unknown etyiology, combined by the development of an acute psychoorganic syndrome. During the 7-day stay in the hospital under permanent laboratory and clinical treatment, aetiology of febrility and acute psychoorganic syndrome remained unknown. Patient died on the 7th day in comma et pulmonary oedema with hyperthermia of 42 degree C. Autopsy showed a macroscopically enlarged brain, weight 1450 g with signs of oedema. Histologycaly we found ME along with cryptococcus neoformans (CN) in leptomeningas and in subarachnoidal spaces, in cerebral cortex and in deeper structure in basal ganglia and capsula interna where we fo-und collections with great accumulation of CN with pseudohyphae by multiplied microglia. In parenchyma of the brain we found disseminated focus of perivascular infiltrator proof CN on paraffin blocks we used histochemical method HE, PAS, Fontana-Masson (Silver stain and modification Fantana-Masson with Mucicarmine, Fontana-Masson with Alcian blue and Fontana- Masson with Nuclear fast red) and immunohistochemical methods CD45 for T lymphocyte and GFAP for astroglia. CME is a rare form of ME, most common in patients with imunodeficiency and this is the first case in our hospital. We found no imunodeficiency in our patient, neither clinically, nor pathoanatomically. We found no changes with CN in other organs.

cryptococcal meningoencephalitis ; intensive care

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