amphotericin-b and Brain-Edema

Clinical worsening or new manifestation of cryptococcal disease following initiation of anti-retroviral therapy (ART) in an HIV patient is a hallmark of cryptococcal immune reconstitution inflammatory syndrome (C-IRIS). However, it can be difficult to distinguish IRIS from worsening or new infection. Here, we present a case of severe C-IRIS involving multiple cerebellar, spinal, and intradural abscesses and spinal arachnoiditis 7 months after ART initiation in an AIDS patient with uncertain prior ART compliance. He had multiple prior episodes of cryptococcal meningitis with complications necessitating ventriculoperitoneal shunt placement and was on suppressive fluconazole when he developed worsening brain manifestations. He received empiric anti-cryptococcal re-induction without improvement. All cerebrospinal fluid cultures remained sterile, with negative

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-Inflammatory Agents; Anti-Retroviral Agents; Antifungal Agents; Arachnoid; Arachnoiditis; Biopsy; Brain; Brain Abscess; Brain Edema; Cerebellar Diseases; Empyema, Subdural; Fluconazole; Flucytosine; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Middle Aged; Prednisone; Recurrence

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Brain Damage, Chronic; Brain Edema; Child; Delayed Diagnosis; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Hydrocephalus; Immunocompetence; Itraconazole; Liposomes; Male; Meningitis; Meningitis, Viral; Prognosis; Stroke, Lacunar; Tuberculosis, Meningeal; Ventriculoperitoneal Shunt

Aspergillosis of the central nervous system is uncommon. It is encountered mainly in the immunocompromised. We describe an unusual case of cerebral aspergillosis in a young but immunocompetent patient. Despite delayed diagnosis, specific anti-fungal therapy lead to a good recovery. Unfortunately, non-adherence with the costly drugs for an adequate period of time was followed by a fatal relapse.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Edema; Female; Humans; Muscle Weakness; Pyrimidines; Seizures; Treatment Outcome; Triazoles; Voriconazole

Eumycetoma in the cerebellopontine angle region is extremely uncommon with no case being reported as per an extensive review of the literature by the authors. The authors report a case of cerebellopontine angle eumycetoma in a young female managed by subtotal decompression and antifungal treatment. The pre-operative diagnosis of eumycetoma in this location is extremely difficult and the role of histopathology is very important to characterize this uncommon lesion. The prognosis of this bizarre pathology is dismal despite all treatment modalities as compared to the usual tumors of the cerebellopontine angle that generally have a favorable outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Edema; Brain Stem; Cerebellar Diseases; Cerebellopontine Angle; Decompression, Surgical; Drug Therapy, Combination; Female; Humans; Hydrocephalus; Ketoconazole; Magnetic Resonance Imaging; Mycetoma; Otitis Media with Effusion; Scedosporium; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

Topics: Acyclovir; Aged; Amphotericin B; Aneurysm; Aneurysm, Infected; Anti-Infective Agents; Brain Edema; Carotid Artery Diseases; Carotid Artery, Internal; Ceftriaxone; Dexamethasone; Embolization, Therapeutic; Equipment Contamination; Female; Humans; Imaging, Three-Dimensional; Infarction, Middle Cerebral Artery; Magnetic Resonance Imaging; Meningoencephalitis; Prostheses and Implants; Prosthesis-Related Infections; Tomography, X-Ray Computed

A case of cryptococcoma involving the right cerebral hemisphere is reported. The diffusion-weighted image shows hypointensity in the central cavity of the cryptococcoma, while apparent diffusion coefficient maps show hyperintensity. The imaging features of an intracerebral cryptococcoma mimic that of a central necrotic brain tumor, rather than a pyogenic brain abscess.

Topics: Amphotericin B; Antifungal Agents; Brain; Brain Edema; Brain Mapping; Cryptococcus neoformans; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Facial Paralysis; Female; Fluconazole; Headache; Humans; Image Enhancement; Magnetic Resonance Imaging; Meningitis, Cryptococcal; Middle Aged; Radiography, Thoracic; Tomography, X-Ray Computed; Treatment Outcome