We report a 24‐year‐old female patient not infected with human immunodeficiency virus (HIV) and without other risk factors of immunosuppression, presenting with neuromeningeal cryptococcosis. Cerebrospinal fluid (CSF) analysis revealed the presence of Cryptococcus neoformans. The evolution was unfavorable and the patient died even after appropriate antifungal treatment.
Rationale:
Systemic lupus erythematosus (SLE) represents a risk of malignancy. The mechanism of carcinogenesis is not fully elucidated. Lymphomas are the most reported cancers in lupus. Other hemopathies have been reported, such as leukemia but remain unusual.
Patient concerns:
We report a 30-year-old woman with SLE diagnosed 20 months ago associated with end-stage renal disease and active hepatitis B. She was treated with hydroxychloroquine and azathioprine, followed by methotrexate. During follow-up, she presented persistent anemia, leukopenia and thrombocytopenia.
Diagnoses:
Following these cytopenias, a bone marrow aspiration was performed. Acute myeloid leukemia associated with SLE was diagnosed.
Interventions:
She received transfusion support and corticosteroid therapy. Methotrexate was stopped and hydroxychloroquine was continued. The patient was not eligible for chemotherapy because of her comorbidities.
Outcomes:
Cytopenias were worsening and unfortunately, she died 3 months later
Lessons:
This observation highlights the importance of regular blood count monitoring during SLE. In case of persistent cytopenia, bone marrow aspiration should be performed to look for an associated hematological malignancy.
Lithiasis by fungus ball is a serious complication of candiduria. Our
case was a 58 year old man who presented an acute obstructive
pyelonephritis. Ultrasound revealed a left ureteral lithiasis.
Biological examination revealed Candida parapsilosis. Antifungal was
beneficial with good evolution. Broad-spectrum antibiotic therapy is one
factor favouring.
We report a 24-year-old female patient with a neurological deficit
without fever or meningeal syndrome. HIV serology was negative and CD4
count was normal. Cerebrospinal fluid analysis revealed the presence of
Cryptococcus neoformans. Neuromeningeal cryptococcosis was suspected.
The initial course was favourable with antifungal therapy.
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