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Case Report

Systemic non-albicans infections presented

as meningitis in chronic hepatitis B patient:

a case report

Wen-Jing Lv, Hui Bu, Jun-Ying He, Ran-Ran Sun, Yue-Li Zou
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China.

ABSTRA CT

Non‑albicans candida meningitis is a relatively rare disease, with nonspecific clinical manifestation, which makes the misdiagnosis occur
sometimes, especially in the early stage of the disease. Abuse of broad‑spectrum antibiotics, corticosteroids, central vein cannulas, senility,
big operation, malignancy, and total parenteral alimentation were all the susceptible factors of non‑albicans candida infection. We present a
case of this type of non‑albicans infection in a 42‑year‑old woman who was early misdiagnosed as tuberculous meningitis and was treated
with antibiotics and antituberculosis agents. The diagnosis of non‑albicans infection was confirmed by fungus culture of the cerebrospinal
fluid (CSF) with a low detectable rate. This case reminds us that the non‑albicans candida meningitis had a nonspecific clinical presentations and
laboratory data, and was difficult to differentiate from tuberculosis meningitis. Hence, we should highly suspect this disease if central nervous
system infections with uncertain pathogens. Test cell counts; protein and fungus culture of CSF should be used to confirm the diagnosis.
Once the diagnosis was established, the patients should receive antifungal treatment based on drug sensitivity tests as early as possible.

Key words: Central nervous system, fungi, non‑albicans candida

INTRODUCTION between 37.5 °C and 38.5 °C and up to 40 °C sometimes,
it increased at dusk and night, accompanied with
Central nervous system (CNS) infection caused by nonprojectile vomiting occasionally and anorexia with
candida is a type of systemic candidiasis. It is rare no visual blurring, diplopia, preceding trauma, or
[1]
in clinical practice, with unnspecific clinical features history of migraine. The fever and headache continued
and laboratory data, which makes this disorder prone for 2 months. Painless intumescent lymph nodes showed
to misdiagnosis. The morbidity of non‑albicans up in the neck 2 months later, and the patient was
candida infection rises in recent years as the abuse diagnosed as tuberculous infection. And treated with
of broad‑spectrum antibiotics and corticosteroids, antibiotics and antituberculosis drugs in local hospitals,
human immunodeficiency virus (HIV) infections, but the symptoms were not relieved. So she came to our
and so on. Here, we present candidal meningitis case hospital for further diagnosis and treatments. Physical
mimics tuberculous meningitis in a chronic hepatitis examination revealed an ill‑looking woman with yellow
B patient. skin, white conjunctiva, and enlarged cervical lymph
nodes. The neurological examination showed neck
CASE REPORT stiffness, positive Kernig’s sign, and negative Babinski
sign on both sides.
A 42‑year‑old female, farmer was admitted in the
Neurology Department of our hospital on November 24 , She received lumber puncture in the local hospital, the
th
2009. Two months earlier, she had a sharp, intermittent pressure of cerebrospinal fluid (CSF) was 265 mmH O,
2
occipital headache and fever, the temperature fluctuated with normal cell counts, glucose, chlorides, and
protein. The white blood cell account was 10.6 × 10 L,
9/
Access this article online the neutrophilic granulocyte percentage was 72.9%.
Quick Response Code: The erythrocyte sedimentation rate was 76 mm/h,
Website: liver function tests showed total bilirubin 75 μmol/L,
www.nnjournal.net
direct bilirubin 40.7 μmol/L, indirect bilirubin 34.3
DOI: μmol/L, aspartate aminotransferase 89 U/L, alanine
10.4103/2347-8659.143681 aminotransferase 67 U/L, alkaline phosphatase 323
U/L, and γ‑glutamyltransferase 400 U/L. Serology for

Corresponding Author: Dr. Hui Bu, Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping
West Road, Shijiazhuang 050000, Hebei, China. E‑mail: buhuimy2@163.com

Neuroimmunol Neuroinflammation | Volume 1 | Issue 3 | December 2014 161