Assuntos
Terapias Fetais/métodos , Meningomielocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Dor Processual/fisiopatologia , Estresse Fisiológico/fisiologia , Adjuvantes Anestésicos/uso terapêutico , Agonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Anestésicos Inalatórios/uso terapêutico , Atropina/uso terapêutico , Feminino , Fentanila/uso terapêutico , Humanos , Injeções Intramusculares , Erros de Medicação , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Dor Processual/prevenção & controle , Fenilefrina/uso terapêutico , Gravidez , Segundo Trimestre da Gravidez , Remifentanil/uso terapêutico , Sevoflurano/uso terapêutico , Brometo de Vecurônio/uso terapêuticoRESUMO
BACKGROUND: Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging. CASE DESCRIPTION: A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required. CONCLUSIONS: This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.