Abstract
Objective: This study aimed to report the case of a female patient with chronic myeloid leukemia affected by cryptococcal meningitis. Case report: ML, white, 48 years old, female sex, previously diagnosed with chronic myeloid leukemia that has been refractive to the use of imatinib and who has recently begun using nilotinib, was admitted complaining of sudden and disabling migraine in the last 1 month associated with asthenia, adinamia, anorexia, disinterest for daily activities, dizziness, nausea, and vomiting. She evolved with ataxia, and started to stroll with help and showed decrease of muscular strength in her upper limbs. She also presented episodes of decrease of consciousness, with look fixation, no respond to sound stimulation, and short-term hearing loss. The cerebrospinal fluid showed presence of Cryptococcus sp. and, therefore, we began treatment with intravenous liposomal amphotericin B in the dose of 3 mg/kg/day, for 6 weeks. A new cerebrospinal fluid analysis, at the end of treatment, also showed rare structures that are compatible with Cryptococcus sp. As sequelae, she continued with hearing loss in her right ear and enhancement in her right auditory canal, seen in the magnetic resonance imaging. After stabilization and clinical improvement, she was discharged. After 3 weeks, she was hospitalized again with degeneration of the condition, and died due to intracranial hypertension secondary to cryptococcal infection. Final Considerations: This report reinforces the need of reflecting on fungi pathologies, especially in immunosuppressant patients, as well as the importance of early diagnosing and making a fast intervention, with the aims of providing quality of life and comfort to the patient and of minimizing neurological sequelae to the patient.
Highlights
Cryptococcosis is one of the systemic infections with higher worldwide prevalence [1]
This study aimed to report the case of a female patient with chronic myeloid leukemia affected by cryptococcal meningitis
Case report: ML, white, 48 years old, female sex, previously diagnosed with chronic myeloid leukemia that has been refractive to the use of imatinib and who has recently begun using nilotinib, was admitted complaining of sudden and disabling migraine in the last 1 month associated with asthenia, adinamia, anorexia, disinterest for daily activities, dizziness, nausea, and vomiting
Summary
Cryptococcosis is one of the systemic infections with higher worldwide prevalence [1]. Infections in this site remain one of the main opportunistic infections and may reach 65% mortality rates, which correspond to 600 thousand deaths per year in immunosuppressed people [4]. Until 2016, estimates showed 60,140 people diagnosed with the disease, which corresponds to 3.4% of all cancers [5]. In Brazil, estimates from the Department of Health show 5540 new cases of leukemia in men and 4530 in women. It is not unusual that opportunistic diseases, such as central nervous system infections, are found in patients with leukemias. As far as we know, there is not a case report of cryptococcal meningitis in patients with CML. We aimed to report the case of a patient with CML affected by cryptococcal meningitis
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