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Vol. 42. Issue S2.
Pages 449-450 (November 2020)
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Vol. 42. Issue S2.
Pages 449-450 (November 2020)
754
Open Access
CASE REPORT: CRYPTOCOCCUS NEOFORMANS ISOLATED FROM A PATIENT WITH NON-HODGKIN'S LYMPHOMA IN THE BRAZILIAN AMAZON
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L.M. Silvaa,b, M.N. Sauniera, W.A. Ferreirab,c, C.M. Ferreiraa,b
a Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, AM, Brazil
b Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
c Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
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Report the conduct of the case of a patient with non-Hodgkin's Lymphoma, from Amazon-Manaus, Brazil. Information was obtained from the patient's medical record and clinical follow-up at the Hematology and Hemotherapy Foundation (HEMOAM-Manaus-Amazonas). A 72 years old, retired farmer, living in the city of Manaus-Amazon-Brazil, sought care at the State Center of Reference in Dermatology” – Alfredo da Matta”Foundation; reported that he observed a tumor approximately 4 cm in diameter in the occipital region, among others distributed difusely throughout the body. A posterior cervical lymph node biopsy was performed and he was diagnosed with non-Hodgkin lymphoma. During the same period, an abdomen scan was ordered, and he was referred to the HEMOAM. On May 06, 2017, he was treated at HEMOAM with generalized pruritus symptom and palpable liver. He was medicated with antihistamine and antipruritic. On July 06, 2017 after consultations with hematologists, blood tests were performed complementary to the diagnosis to start chemotherapy of LYMPHOMA. On Dezember 06, 2017 the patient presented: abdominal computed tomography: cervical region with expansive/infltrative lymph node mass, determining almost complete thrombosis of the left internal jugular vein+pulmonary emphysema+multiple mediastinal and axillary lymph node enlargement involving visceral/level and left internal mammary chain, retroperitoneal and mesenteric, inguinal, thoraco-lumbar and internal jugular vein thrombosis (tumor compression); and Hepatitis C reagent. The patient was submitted to chemotherapy protocol from August 08, 2017 until October 10, 2017. Still under the chemotherapy protocol for lymphoma, the patient presented a fever 37.5°C, coryza, sneezing, and elevation of transaminases with rates three times above normal limits. Subsequently, he attended the HEMOAM emergency room reporting weakness, a febrile peak of 38°C, vertigo, lack of appetite, nausea and epigastralgia. Te laboratory fndings were as follows: Haemoglobin (Hb): 12.6g/L; Hematocrit (Ht) 36.8%; Platelet: 101,000/mm3; neutrophil: 9.8%; leucocyte: 2400/mm3; positive blood culture for Cryptococcus neoformans, and the diagnosis of Aplasia after chemotherapy. The patient was admitted for parenteral treatment with the antibiotics cefepime+clarithromycin and blood cultures were performed. However, due to his worsening clinical conditions, he was transferred to a University Hospital in Manaus on November 06, 2017. Remaining in the ward of the University Hospital, the patient started treatment with Fluconazol 200 mg for 14 days, after culture result identifying the presence of yeasts. The patient continued in the ward, with worsening clinical evolution of: pulmonary infection+Neurological syndrome +Hydroelectrolytic disturbance+Intestinal constipation+Plaquetopenia. Cefepime and Clarithromycin empirically therapy was discontinued, substituted by the Meropenem antibiotic. From November 07, 2017 to November 09, 2017 the clinical condition evolved to cardio-respiratory arrest in Asystole, followed by resuscitation and transferred to the Intensive Care Unit; still critical under antibiotic therapy, another cardiac arrest on November 09, 2017 and, due to respiratory septic shock, evolved to death. The disease has variable clinical and pathological presentations and can manifest itself both in patients with normal immunity and in immunocompromised patients, who represent the majority of cases.

Idiomas
Hematology, Transfusion and Cell Therapy
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