Bilateral Cranial Nerve VI Palsies in Cryptococcal Meningitis, HIV, and Syphilis: A Case Report

Introduction: Cranial nerve (CN) VI palsy is a common complaint seen in the emergency department (ED) and has a wide range of causes. Bilateral CN VI palsies are uncommon and appear to be associated with more severe complications. Case Report: A 29-year-old male presented to the ED from an ophthalmology office for diplopia, headache, and strabismus. He was found to have bilateral CN VI palsies and new-onset seizure in the ED. A lumbar puncture revealed cryptococcal meningitis. Additional tests revealed a new diagnosis of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and syphilis. Conclusion: Cryptococcal meningitis remains a life-threatening complication of HIV/AIDS. Coinfections with HIV, particularly syphilis, further complicate a patient’s prognosis as both can lead to devastating neurological sequelae. In cryptococcal meningitis, elevated intracranial pressure is a complication that can manifest as seizures, altered mental status, and cranial nerve palsies.

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An Uncommon Presentation of Cryptococcal Meningitis in an Immunocompetent Patient: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.8.53368 ◽

2021 ◽

Vol 5 (4) ◽

pp. 450-454

Author(s):

Kelly Correa ◽

Scott Craver ◽

Amar Sandhu

Keyword(s):

Case Report ◽

Cryptococcal Meningitis ◽

Altered Mental Status ◽

Immunocompetent Patient ◽

Significant Past Medical History ◽

Atypical Symptoms ◽

Presenting Symptoms ◽

Uncommon Presentation ◽

Life Threatening ◽

Immunocompetent Patients

Introduction: Meningitis is a serious and potentially life-threatening infection of the central nervous system. Cryptococcus neoformans is a rare fungal cause of meningitis that commonly presents with atypical symptoms. Although this infection is most common in immunocompromised patients, it also occurs in immunocompetent patients. This case report describes an atypical presentation of cryptococcal meningitis in a seemingly immunocompetent patient. Case Report: A 40-year-old immunocompetent patient with no significant past medical history had visited the emergency department (ED) five times within a span of 30 days reporting dental pain and headache. Throughout each of the visits, no clear symptoms signaling the need for a meningitis workup were observed, as the patient had been afebrile, displayed no nuchal rigidity, and his presenting symptoms subsided within the ED after treatment. A lumbar puncture was performed after emergency medical services brought the patient in for his sixth ED visit, initially for stroke-like symptoms and altered mental status. Spinal fluid was indicative of cryptococcal meningitis. Conclusion: This case highlights the challenge of identifying cryptococcal meningitis in the ED, particularly in immunocompetent patients who do not display classic meningitis symptoms. It also highlights the importance of keeping a broad differential and carefully ruling out diagnoses when patients return to the ED multiple times for the same complaint.

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Non-Hodgkin’s Plasmablastic Lymphoma as Initial Presentation of Human Immunodeficiency Virus

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211014689 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110146

Author(s):

Roopam Jariwal ◽

Nadia Raza ◽

Janpreet Bhandohal ◽

Everardo Cobos

Keyword(s):

Human Immunodeficiency Virus ◽

Acquired Immunodeficiency Syndrome ◽

Initial Presentation ◽

Plasmablastic Lymphoma ◽

Healthy Male ◽

Immunodeficiency Virus ◽

Life Threatening ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Head Neck

Plasmablastic lymphoma (PBL) is a subtype of non-Hodgkin’s lymphoma that manifests in patients with the diagnosis of human immunodeficiency virus (HIV), more prominently in the head, neck, and oral mucosal region. The diagnosis of this rare lymphoma serves as a concomitant diagnosis of acquired immunodeficiency syndrome. The case is of a 33-year-old previously healthy male, with an unknown diagnosis of HIV with a painful right mandibular mass. He was subsequently diagnosed with PBL and HIV. This case of PBL illustrates the importance of linking a rare and potentially life-threatening diagnosis as a possible first manifestation of HIV.

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Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report

Revista Iberoamericana de Micología ◽

10.1016/j.riam.2020.09.003 ◽

2020 ◽

Author(s):

Paulo Mendes Peçanha ◽

Isabela Cruz Bahiense ◽

Wdson Luis Lima Kruschewsky ◽

Cláudia Biasutti ◽

Carlos Urbano Gonçalves Ferreira Júnior ◽

...

Keyword(s):

Case Report ◽

Acquired Immunodeficiency Syndrome ◽

Paracoccidioides Brasiliensis ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Mycobacterium avium complex and Cryptococcus neoformans co-infection in a patient with acquired immunodeficiency syndrome: a case report

Acta Clinica Belgica ◽

10.1080/17843286.2021.1919845 ◽

2021 ◽

pp. 1-6

Author(s):

Emilien Gregoire ◽

Benoit François Pirotte ◽

Filip Moerman ◽

Antoine Altdorfer ◽

Laura Gaspard ◽

...

Keyword(s):

Case Report ◽

Cryptococcus Neoformans ◽

Mycobacterium Avium ◽

Acquired Immunodeficiency Syndrome ◽

Mycobacterium Avium Complex ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Effects of Atovaquone on the Ultrastructural Morphology of Pneumocystis Carinii

Microscopy and Microanalysis ◽

10.1017/s1431927600007297 ◽

1997 ◽

Vol 3 (S2) ◽

pp. 81-82

Author(s):

M.P. Goheen ◽

M.S. Bartlett ◽

M.M. Shaw ◽

S.R. Meshnick ◽

J.W. Smith

Keyword(s):

Adverse Reactions ◽

Pneumocystis Carinii ◽

Spinner Flask ◽

Short Term ◽

Human Embryonic Lung ◽

Transmission Electron ◽

Significant Incidence ◽

Wide Range ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Pneumocystis carinii pneumonia (PCP) occurs at some time in most patients with acquired immunodeficiency syndrome (AIDS). Trimethoprim/sulfamethoxazole or pentamidine isothionate are the traditional modes of therapy for treatment and prophylaxis of PCP. Unfortunately these drugs are associated with a significant incidence of adverse side effects particularly in patients with AIDS. Toxicity and a growing concern that P. carinii strains are becoming resistant to these compounds is providing the impetus for the search for additional drugs to combat P. carinii. Atovaquone, developed as an antimalarial agent, has activity against a wide range of other organisms, including Toxoplasma sp. and P. carinii, with a lower incidence of adverse reactions during clinical trials. Atovaquone inhibits mitochondrial respiration in P. falciparum and P. carinii. In this study transmission electron microscopy (TEM) was used to observe the effects of atovaquone on P. carinii organisms in short term spinner flask culture.Spinner flask cultures of human embryonic lung cells were inoculated with P. carinii from infected rat lung.

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Disseminated Calcification with Predominant Muscle and Cerebral Involvement in a Child with Acquired Immunodeficiency Syndrome: A Case Report

Pediatric Pathology & Laboratory Medicine ◽

10.1080/15513819709168736 ◽

1997 ◽

Vol 17 (4) ◽

pp. 593-600 ◽

Cited By ~ 1

Author(s):

Jinsong Liu ◽

Muhammadsamir A. Sulh ◽

David Zagzag ◽

Richard Reuben ◽

M. Alba Greco

Keyword(s):

Case Report ◽

Acquired Immunodeficiency Syndrome ◽

Cerebral Involvement ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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HIV/AIDS and traditional healers: a blessing in disguise

Medicine Science and the Law ◽

10.1258/msl.2010.010006 ◽

2010 ◽

Vol 50 (3) ◽

pp. 154-155

Author(s):

B L Meel

Keyword(s):

Case Reports ◽

Health Care Systems ◽

Traditional Healers ◽

Immunodeficiency Virus ◽

Herbal Decoction ◽

Care Systems ◽

Life Threatening ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Hiv Aids

Traditional healers contribute significantly to the level of health-care systems in Africa. They could play an important role in the prevention and care of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community. The traditional healing system deals with psychosocial stress associated with HIV/AIDS as well as herbal medications. Sometimes, herbal medicine causes serious life-threatening complications. Two case reports are presented in this article. The first is a 48-year-old woman with HIV who was made to drink a large volume of a herbal decoction to stimulate vomiting in the belief that cleansing the bowel would rid the system of the disease. The second is a 25-year-old young man who had a herbal enema, which resulted in gangrene of the large bowel. The case histories, mechanism of action and causes of death are discussed.

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