Female patient, 13 years old, with no morbid history.
She was hospitalized due to a febrile syndrome of one month of evolution, with cutaneous lesions not well catalogued and colitis in the lower third of the left.
He had a significant nutritional impact with BMI 14.1 (Z <-2).
ELISA and Westernblot were performed for HIV, which were positive. Mother, father and siblings with negative serology were also studied.
There was no history of hospitalizations or blood product transfusions.
Family members denied the possibility of sexual abuse and gynecological examination was normal.
AZT, 3TC and lopinavir/ritonavir, with CD4 lymphocytes CD4 count.
Subsequently, she presented several episodes interpreted as cutaneous reactions to therapy so the use of antihistamines and corticosteroids was necessary.
Two months after the onset of symptoms, the patient was hospitalized due to fever, diplopia, headache and vomiting, and acute meningitis was diagnosed.
The cytochemical analysis of CSF: glucose 0.39 g/l, proteins 0.57 g/l, lactate 2.03 mmol/l, leukocytes: not observed and erythrocytes: 520/mm3.
Chinese ink staining was positive and C. neoformans was isolated from the culture.
He was treated with amphotericin B deoxycholate IV for 10 days and then liposomal amphotericin B for developing secondary renal failure.
Magnetic resonance imaging was normal and a fundus examination showed bilateral papilledema.
After 15 days, CSF control, cytochemical analysis: glucose 0.21 g/l, proteins 1.57 g/l, lactate 3.59 mmol/l, leukocytes: no erythrocytes: 200/mm3 were observed.
The CSF culture remained positive for C. neoformans, negative at one month of treatment; however, she presented an intensification of headache and seizures and was discharged from the intensive care unit.
Its clinical deterioration was interpreted as an inflammatory response syndrome, which was managed with intravenous corticosteroids.
The patient was discharged after 51 days of hospitalization.
The patient remained with progressive increase of CD4 lymphocytes up to 240/mm3 and undetectable VC.
