Neurocriptococose cursando com síndromes parkinsoniana e demencial de lenta progressão

Abstract

Central nervous system's infection by Cryptococcus neoformans occurs in both immunocompetent and in immunosuppressed patients; common symptoms include headache, photophobia, nausea and decreased level of consciousness. This clinical picture is nonspecific and contributes to the delay in diagnosis, which increases the risk of permanent sequelae. However, some patients have atypical symptoms that do not direct the clinical rationale for this agent. Treatment is based on antifungal therapy including amphotericin B and/or imidazole derivatives and repeated lumbar punctures, to reduce intracranial pressure, which is also directly related to the outcome. We report the case of a middle-aged man, with atypical clinical picture, including slowly, progressive parkinsonian and psychiatric symptoms. Lumbar puncture revealed the presence of that fungus in cerebrospinal fluid. Proper treatment allowed general symptomatic and important clinical improvement. Key words: Secondary Parkinson disease – Cryptococcus – Encephalitis