Myasthenia gravis complicated with cryptococcal meningitis after thymectomy and long-term immunosuppressive therapy

Abstract

Letters seen in stroke but with hypometabolism possibly representing a phenomenon of diaschisis. Serial FDG-PET examinations showed markedly increased activity in the basal ganglia as compared with that in the cortex when extrapyramidal features were prominent, which normalised after improvement of this movement disorder 4 . In the setting of paraneoplastic neurological syndrome, FDG-PET imaging can be of value from the following standpoints: [1] detection of the occult malignant focus and [2] objective assessment of the presence and extent of the functional abnormality in the brain and correlation of the imaging findings with the clinical features and disease activity 5 . The literature describing the central nervous system findings with PET in paraneoplastic neurological syndromes are primarily restricted to paraneoplastic limbic encephalitis. FDG-PET usually shows hypermetabolism in one or both temporal lobes, and the magnetic resonance imaging (MRI) findings correlate with the FDG-PET scan results in only a fraction of cases. FDG-PET images can provide additional clinical information which is of great value in further patient management.In conclusions, the FDG-PET more often than the MRI revealed abnormalities in the brainstem, cerebral cortex or cerebellum, some of them clinically silent.FDG-PET might be useful in the evaluation of patients suspected for NMDA receptor encephalitis, but studies to asses the utility for prognosis and treatment planning are necessary.

Abordagem de crise miastênica infanto-juvenil: relato de caso

“…Tendo em vista também o aumento dos quadros de insuficiência respiratória aguda por infecção pelo coronavírus, onde apresenta sintomas agudos, característicos que é facilmente uma hipótese diagnóstica (Meriggioli et al 2009). Em alguns pacientes o diagnóstico se torna difícil principalmente aqueles que cursam com quadro de fraqueza focal de determinados grupos musculares, como os músculos respiratórios (Lorenzoni et al 2011), além de existir um longo período entre a instalação dos sintomas e o diagnóstico (Santos et al 2014). A dificuldade no diagnóstico ocorre pelo fato da MG ser uma doença relativamente rara, e apresentar sintomas semelhantes aos de doenças mais comuns, como acidente vascular encefálico, doença do neurônio motor ou histeria podem ser diagnosticados erroneamente (Souza et al 2014).…”

Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy – a case report

“…And although not surprising in a MG patient on chronic immunosuppression, this is only the eighth case reporting on such association. Infections in previously reported cases were in the forms of meningitis in three cases [8, 9, 11], prostatic abscess in one case [21], prosthetic joint infection in one case [22], cryptococcal cellulitis [10] in one case and disseminated cryptococcal infection in one case [23]. …”

“…More recently, with the use of immunosuppressive therapy or surgical removal of thymus gland the general outlook for MG has improved dramatically [8]. Generalized immune suppression from the MG treatment compromises the immune system as a whole with increased susceptibility to infections, including opportunistic infections, and neoplasia [9–11]. Here, we reported a complicated case of a predominantly cutaneous cryptococcosis that progressed later to meningitis in a myasthenia gravis patient on chronic immunosuppressive therapy.…”

Morphological and Molecular Characterization of Exophiala polymorpha sp. nov. Isolated from Sporotrichoid Lymphocutaneous Lesions in a Patient with Myasthenia Gravis

“…Although previous case reports of infections due to Exophiala species in patients with myasthenia gravis were not found in a search of the literature, there are reports of invasive fungal infections in patients with this disease. Some of these include dermatophytosis secondary to Trichophyton rubrum (6), Candida esophagitis (32), various cases of cryptococcal meningitis and cryptococcal cellulitis (33)(34)(35), and one case of subcutaneous phaeohyphomycosis of the foot caused by Phoma minutella (36).…”