Neurocutaneous melanosis
نویسندگان
چکیده
Radiol Bras. 2016 Nov/Dez;49(6):406–413 412 http://dx.doi.org/10.1590/0100-3984.2015.0139 the lesions by the paramagnetic contrast agent. Examination of the cerebrospinal fluid showed that there was no infection with Cryptococcus or any other agents, indicating an effective response to the treatment. The combination of clinical and radiological worsening, despite an effective treatment response, in a patient with evidence of immunosuppression (probably due to nutritional restriction), strongly suggested immune reconstitution inflammatory syndrome (IRIS). The antifungal therapy was maintained, and corticosteroid therapy was started, resulting in significant clinical improvement and regression of the lesions seen on follow-up imaging studies (Figure 1D). In immunocompromised patients, cryptococcosis is common and is mainly caused by inhalation of Cryptococcus neoformans or Cryptococcus gattii. Many patients with cryptococcosis develop pulmonary colonization, which is often asymptomatic. The symptoms become pronounced when they evolve to meningoencephalitis, presenting high tropism for the leptomeninges. The presentations include masses and pulmonary consolidations, gelatinous cystic formations in the brain, especially in the thalamus and basal nuclei. The differential diagnoses include lung cancer with brain metastasis. The diagnosis is made by identifying the fungus in sputum samples, bronchoalveolar lavage fluid, cerebrospinal fluid, histological sections, or culture. Fluconazole and amphotericin-B are therapeutic options. Malnutrition is a known cause of immunodeficiency, affecting the mechanisms of adaptive immunity. Some patients with acquired immunodeficiency syndrome or immunosuppression develop IRIS, in which the immune system begins to recover, responding to a previously acquired opportunistic infection with an exuberant inflammatory response that paradoxically causes a worsening of the symptoms. Here, we have described an unusual case suggestive of cryptococcosis-related IRIS in an HIVnegative patient, probably developing immunosuppression due to nutritional restriction for weight loss.
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