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Abstract: A 27-year-old patient presented with symptoms of high fever and headache with no apparent cause 1 month ago, and was seen in our hospital after multiple visits to outside hospitals without significant improvement, and after progressive worsening of blurred vision and hearing loss, he was diagnosed with cryptococcal meningitis, a fungal meningitis, after examination. After treatment with standard medication, the patient’s headache and vomiting were relieved and her condition gradually recovered.
Basic information】Female, 27 years old
Disease Type】Cryptococcal meningitis
Hospital】The Second Hospital of Guangzhou Medical University
Date of Consultation】October 2020
Treatment plan】Intravenous injection (mannitol injection, amphotericin B for injection, fluconazole sodium chloride injection, glucose sodium chloride injection)
Treatment period】10 weeks of hospitalization and follow-up for discomfort
Treatment effect】The patient’s headache and vomiting were relieved and her condition gradually recovered.
I. Initial consultation
Patient Ms. Zhang, 27 years old, reported that she developed high fever and headache with no obvious cause one month ago, starting from the right temporal region, then shifting to the left side, gradually spreading to the whole head, with distension and pain, accompanied by nausea, vomiting, tinnitus, hearing loss, unstable walking, weakness of limbs, blurred vision, no slurred speech, difficulty in swallowing, choking and coughing, no involuntary movement of limbs, limb twitching, unconsciousness, no chest tightness, chest pain, shortness of breath, dyspnea, etc. Chest pain, shortness of breath, dyspnea, etc. The patient has been treated several times outside the hospital, but no significant improvement has been seen, and the blurred vision and hearing loss have progressively worsened. There was no special personal history or family history, and intracranial infection was suspected initially.
II. Treatment history
The patient was examined after admission: no significant abnormalities were seen in the heart, lungs and abdomen, and no pathological reflexes were elicited. The patient’s neck was tense, chin-thorax distance was 4 transverse fingers, and Knee’s sign was positive. After admission, a lumbar puncture was performed to find cryptococcal spores. Further examination showed no significant abnormalities in the brain parenchyma and no abnormalities in the venous sinuses. Soft meningeal enhancement, bilateral septal sinus and maxillary sinus inflammation. Cerebrospinal fluid routine: white blood cell count 330×10^6/L, mNGS (macrogenome sequencing) examination showed positive for Cryptococcus. The patient mentioned that poultry was fed on the rooftop of the neighbor’s house, which may have caused fungal infection through exposure to poultry or other contaminants, which in turn induced cryptococcal meningitis. After the diagnosis was confirmed, the patient was given mannitol injection for intravenous dehydration to lower the cranial pressure, glucose sodium chloride injection to maintain electrolyte balance, and injectable amphotericin B and fluconazole sodium chloride injection for antifungal treatment.
III. Treatment effect
After 3 days of infusion, the patient’s headache and fever improved, and the temperature fluctuated from 38.2℃ to 38.8℃, the headache was significantly reduced, and the stiffness of the neck was also improved on physical examination. 1 week later, the lumbar puncture examination was repeated, and the white blood cell count and microprotein level decreased significantly. 1 month later, the patient’s lumbar puncture examination was repeated, and all the indexes gradually improved without obvious discomfort. 10 weeks later, the lumbar puncture After 10 weeks, the indicators returned to normal and the patient was basically recovered and discharged.
IV. Notes
We are glad that the patient finally recovered from the disease. After discharge, the patient should pay attention to relax, ensure sleep, combine work and rest, and live regularly. Family members and themselves should closely observe the symptoms, while strengthening nutrition, exercising and improving resistance. Pay attention to avoid contact with poultry to avoid re-infection with fungus and cause recurrence of the disease. If you have dizziness, headache, vomiting and other symptoms, come to the hospital at any time.
V. Personal insight
Cryptococcal meningitis is a common fungal meningitis, which can have the same symptoms of high fever, persistent severe headache, nausea and vomiting as the patient in this case, and symptoms such as blurred vision and hearing impairment because of the high intracranial pressure, which may affect the cranial nerves. If the disease is not treated in a timely and standardized manner, further development of the disease may lead to coma, cardiac and respiratory arrest, and other symptoms, which may be life-threatening. For fungal meningitis, it is important to detect and treat it early, while paying attention to standardized treatment.