Cryptococcus gattii Meningitis in a Previously Healthy Young Woman: A Case Report

Introduction: Cryptococcus gattii (C. gatti) is a rare cause of meningitis in the United States. Outbreaks in new geographic distributions in the past few decades raise concern that climate change may be contributing to a broader distribution of this pathogen. We review a case of C. gattii in a 23-year-old woman in Northern California who was diagnosed via lumbar puncture after six weeks of headache, blurred vision, and tinnitus. Case Report: A 23-year-old previously healthy young woman presented to the emergency department (ED) after multiple visits to primary care, other EDs, and neurologists, for several weeks of headache, nausea, tinnitus, and blurred vision. On examination the patient was found to have a cranial nerve VI palsy (impaired abduction of the left eye) and bilateral papilledema on exam. Lumbar puncture had a significantly elevated opening pressure. Cerebrospinal fluid studies were positive for C. gattii. The patient was treated with serial lumbar punctures, followed by lumbar drain, as well as amphotericin and flucytosine. The patient had improvement in headache and neurologic symptoms and was discharged to another facility that specializes in management of this disease to undergo further treatment with immunomodulators and steroids. Conclusion: Fungal meningitis is uncommon in the US, particularly among immunocompetent patients. Due to climate change, C. gattii may be a new pathogen to consider. This finding raises important questions to the medical community about the way global climate change affects day to day medical care now, and how it may change in the future.

Bilateral symmetric ankles and feet cellulitis after fish pedicure: Case report and review of the literature

Fish pedicure (feet immersion in a tank containing fish Garra rufa or Cyprinion macrostomus) is a widely diffuse cosmetic practice, usually considered safe. However, this practice is regulated only in a few Countries, and the risk of infection related to this practice is not quantified. We report a case of bilateral symmetric ankles and feet cellulitis in a previously healthy young woman without risk factors for infections, after a fish pedicure in Greece. Three cases of foot infection after fish pedicure have been described in the English literature, two sustained by S. aureus and one by Mycobacterium marinum, but none of them was so extensive, involving not only feet but also ankles. The practice of the aesthetic fish pedicure should be regulated in all Countries to reduce the risk of complications related to this procedure. Moreover, studies targeted at investigating the risk of infection associated with this procedure are warranted. Keywords: Fish pedicure; Cosmetic procedure; Cellulitis; Risk infection.

Anterior and posterior ischemic optic neuropathy following liposuction surgery in a previously healthy young woman

A previously healthy 28-year-old female developed bilateral painless vision loss, more prominent in the right eye than in the left, following abdominoplasty and liposuction surgery. Laboratory studies showed severe peri- and post-operative anemia. Over a 5-month follow-up, visual function remained decreased but stable in the right eye and improved in the left eye. This is the second reported case of anterior ischemic optic neuropathy in one eye and posterior ischemic optic neuropathy in the other eye after liposuction. Level of evidence: Level VI, case report study.