Sicsik-Aragón A, Cosaín-Valles CE, Vazquez-Espiritu G, Saldaña-Xolalpa J, Estrada-Valencia M, Romero-Mera J, Núñez-Orozco L

Language: Spanish
References: 10
Page: 63-68
PDF size: 940.00 Kb.

ABSTRACT

Fungal meningitis has a subacute and chronic course. In severe cases it is associated with vascular phenomena leading to cerebral infarction or mycotic aneurysm formation. The main symptoms include headache of insidious onset, accompanied by nuchal rigidity, intermittent fever and nocturnal diaphoresis. Acute focal deficits correspond with involvement of the cerebrovascular territories involved. We report a series of three cases of patients undergoing epidural anesthesia procedures, who developed symptoms and neurovascular complications of subacute meningitis due to direct inoculation of Fusarium solani; it is recognized as a saprophytic fungus that in immunocompetent human's results in keratitis while in immunocompromised patients it produces severe symptomatology of invasive fungiosis. The patients developed symptoms in an average of three to four weeks after the lumbar spine puncture, which caused fungal meningitis based on compatible data taken, consisting on isolation of the agent by PCR and neuroimaging studies with diverse neurovascular alterations, including a case of infarction in the mescencephalon-pontine unction, and imaging data of medium and small vessel vasculitis. They were treated with dual regimens of amphotericin B and voriconazole until remission of symptoms and normalization of cerebrospinal fluid parameters.

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