International Journal of Gerontology
Volume 2, Issue 3 , Pages 128-132, September 2008

An Unusual Presentation of Postural Headache Caused by Cryptococcus neoformans Meningitis in an Elderly Person

Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan

Accepted 8 April 2008.

Article Outline

Summary 

Headache is a common complaint in the emergency department (ED). It is crucial and challenging for ED physicians to differentiate life-threatening causes from benign ones. We present a 64-year-old male who attended our ED suffering from dizziness and elevated blood pressure for the previous 2 days. He had also suffered from headache during the 2 weeks prior to his presentation at the ED. The patient had a medical history of hypertension and hepatitis B. After a thorough investigation, including a cerebrospinal fluid (CSF) analysis, his blood and CSF showed high titers of Cryptococcus. Empirical antifungal antibiotics were given after the CSF analysis. After 50 days of amphotericin B and fluconazole therapy, he was discharged with oral fluconazole (400mg/day) and followed up in the outpatient department.

Key Words:  chronic meningitis , cryptococcal meningitis , headache , immunocompetent

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References 

  1. Thomas KE , Hasbun R , Jekel J , Quagliarello VJ . The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis . Clin Infect Dis . 2002;35:46–52
  2. Attia J , Hatala R , Cook DJ , Wong JG . Does this adult patient have acute meningitis? . JAMA . 1999;282:175–181
  3. Parrino TA . Review: the physical examination can exclude the diagnosis of meningitis in low-risk adults . Evid Based Med . 2000;5:28
  4. Tan AK , Yeow YK . Warning symptoms of sinister headache . Singapore Med J . 1994;35:294–297
  5. Bicanic T , Harrison TS . Cryptococcal meningitis . Br Med Bull . 2005;72:99–118
  6. Mitchell DH , Sorrell TC , Allworth AM , Heath CH , McGregor AR , Papanaoum K , et al.   Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome . Clin Infect Dis . 1995;20:611–616
  7. Speed B , Dunt D . Clinical and host differences between infections with the two varieties of Cryptococcus neoformans . Clin Infect Dis . 1995;21:28–34 discussion 35–6.
  8. Saag MS , Graybill RJ , Larsen RA , Pappas PG , Perfect JR , Powderly WG , et al.   Practice guidelines for the management of cryptococcal disease . Clin Infect Dis . 2000;30:710–718
  9. Pappas PG , Perfect JR , Cloud GA , Larsen RA , Pankey GA , Lancaster DJ , et al.   Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy . Clin Infect Dis . 2001;33:690–699
  10. Brouwer AE , Rajanuwong A , Chierakul W , Griffin GE , Larsen RA , White NJ , et al.   Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial . Lancet . 2004;363:1764–1767
  11. Larsen RA , Bauer M , Thomas AM , Graybill JR . Amphotericin B and fluconazole, a potent combination therapy for Cryptococcal meningitis . Antimicrob Agents Chemother . 2004;48:985–991
  12. Fessler RD , Sobel J , Guyot L , Crane L , Vazquez J , Szuba MJ , et al.   Management of elevated intracranial pressure in patients with cryptococcal meningitis . J Acquir Immune Defic Syndr Hum Retrovirol . 1998;17:137–142
  13. Denning DW , Armstrong RW , Lewis BH , Stevens DA . Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome . Am J Med . 1991;91:267–272
  14. Graybill JR , Sobel J , Saag M , van der Horst C , Powderly W , Cloud G , et al.   Cerebrospinal fluid hypertension patients with AIDS and cryptococcal meningitis [abstract I-153]. Program and Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (Toronto, ON, Canada) . Washington, DC: American Society for Microbiology; 1997;
  15. Lu CH , Chang WN , Chang HW , Chuang YC . The prognostic factors of cryptococcal meningitis in HIV-negative patients . J Hosp Infect . 1999;42:313–320
  16. Dromer F , Mathoulin S , Dupont B , Letenneur L , Ronin O . Individual and environmental factors associated with infection due to Cryptococcus neoformans serotype D. French Cryptococcosis Study Group . Clin Infect Dis . 1996;23:91–96
  17. Dismukes WE , Cloud G , Gallis HA , Kerkering TM , Medoff G , Craven PC , et al.   Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks . N Engl J Med . 1987;317:334–341
  18. Chuck SL , Sande MA . Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome . N Engl J Med . 1989;321:794–799

PII: S1873-9598(08)70051-6

doi:10.1016/S1873-9598(08)70051-6

International Journal of Gerontology
Volume 2, Issue 3 , Pages 128-132, September 2008

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