Context: Cryptococcosis is an important fungal infection that, after AIDS development globally, became more common, being an important cause of opportunistic infections. The pathogen normally gets in through the lungs, causes pulmonary infection and then spreads to another systems, particularly the nervous system in most cases. Along the clinical manifestation there was headache, fever, cranial neuropathies, altered mentation, lethargy, memory loss, and signals of meningeal irritation. Case-Report: A 48-year-old male patient with a one-year story of paraparesis in both legs, associated with pain, paresthesia, and progressive worsening to complete walking incapability, seeks medical consultation. Cerebrospinal fluid was turbid appearance, yellow colored, presence of RBC (1.239 cel/mm³) and leukocytes (149 cel/mm³ - 5% neutrophils, 91% lymphocytes and 4% monocytes), glucose of 23 mg/dL, chlorine of 96 mmol/L, and Cryptococcus neoformans was isolated. Immunosuppressive disease wasn´t found. In MRI, there were nodular images in the intradural and extradural sites through T11-T12 levels, compressing the spinal cord. Local biopsy revealed chronic granulomatous inflammatory process, consistent with the cryptococcosis suspect. Conclusions: The case represents an unusual manifestation of cryptococcosis, with an uncommon topography and profile, once it´s manifestation medullary and in a healthy individual is rare. The main differential diagnosis was spinal tuberculosis, an also rare disease yet with similar symptoms and relevant local epidemiology. To reach the diagnosis, laboratory study was necessary. The treatment was the same of cryptococcosis in general.
Case report: Medullary cryptococcosis in a immunocompetent patient
