Meningoencefalite por Cryptococcus neoformans como complicação de insuficiência vascular arteriosclerótica em hanseníase virchowiana

Abstract

A 39 year old white man, with advanced Virchowian hanseniasis died with signs of extensive meningeal involvement. His medical background showed repeated episodes of Erythema nodosum hansenicum (ENH) in the last three years of his life, besides ischemic gangrena with amputation of the left leg and cerebral vascular ischemic attacks. The autopsy revealed an advanced stage of arteriosclerosis affecting mainly the brain and the distal segment of the aorta and its ramifications. A propagating thrombus was found along the left femoral and iliac arteries and in the terminal portion of the aorta extending to the renal arteries. Thrombosis was also found along the left femoral vein, left iliac vein and distal segment of the inferior cava. The brain showed anemic infarction in organization and a generalized meningoencephalic involvement with granulomatous reaction caused by Cryptococcus neoformans. It was suggested a possible relationship between Erythema nodosum reactions and thrombosis phenomena. Torulosis was considered as a final occurrence and the proliferative vasculitis due to the granulomatous process in the sub-arachnoidal space has certainly aggravated the cerebral ischemia.