Neuromeningeal cryptococcosis complicated by hydrocephalus in an HIV negative child.

Abstract

Neuromeningeal cryptococcosis (CNM) is a serious cosmopolitan mycosis, generally affecting people with a deficient cellular immunity, especially those who are seropositive to the human immunodeficiency virus (HIV). We report the observation of a case in a 7-year-old girl, admitted for deterioration of general condition, disorder of consciousness (Glasgow at 8/15), meningeal syndrome (stiffness of the neck, Kernig's sign and Brudzinski) and quadriplegia predominantly on the left. Computed tomography (CT) of the brain showed dilation of all the ventricular chambers with cerebral periventricular hypodensity. The lumbar puncture (PL) brought back clear cerebrospinal fluid (CSL). LCS analysis found pleocytic, hyperproteinorachic, hypoglycorachic meningitis and Cryptococcus neoformans. Antifungal therapy combining amphotericin B and fluconazole had been initiated. The patient also had surgical drainage for hydrocephalus. After 12 weeks of hospitalization, death occurred in the context of deterioration of general condition, recurrent convulsions and deep coma.Neuromeningeal cryptococcosis poses a serious problem of diagnosis and treatment in immunocompetent children because of insufficient means of investigation and treatment.