Concurrent presentation of cryptococcal meningoencephalitis and systemic lupus erythematosus

Abstract

Cryptococcal meningitis is a recognized complication of systemic lupus erythematosus (SLE), with high mortality rates, particularly in those treated with immunosuppressive agents. We describe a patient diagnosed simultaneously with cryptococcal meningoencephalitis and SLE and reviewed four similar cases reported in the literature. In our case, profound low CD4 lymphocyte count and low complement levels were observed. The patient was treated with prednisolone, fluconazole, and 5-flucytosine and evinced good clinical improvement. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections.

Sepsis with cerebral lupus…. or is it? A case report on Cryptococcaemia

“…Despite antifungal therapy, the consequences of cryptococcal meningitis are disastrous, as mortality is around 40-50%, even with antifungal therapy. 5 C. neoformans can be isolated from the blood, as in our patient, only in around 10% to 30% patients with cryptococcal disease. 6 It should be noted that when this happens, in those with cryptococcal meningitis, it heralds a poor prognosis.…”

“…4 Cryptococcal meningitis is the foremost cause of mortality (85.7%) in patients with SLE who have invasive fungal infections. 5 The reasons for this are multifactorial and include its non-specific clinical presentation in the early stage of infection, misjudging the risk for cryptococcal meningitis and misdiagnosis as psychosis due to steroids, cerebral lupus and other non-fungal pathogens. 2 This leads to inappropriate therapy and delays in administration of antifungal agents.…”

Systemic lupus erythematosus complicated with cryptococcal meningitis: A case report

“…[ 11 ] In addition, immune abnormalities associated with SLE, such as immunoglobulin deficiency, complement deficiency, and reduced complement receptor expression, increase the likelihood of developing opportunistic infections, especially fungal infections. [ 12 ] Thus, SLE patients are vulnerable to cryptococcus.…”

Pseudomonas bacteremia as an initial presentation of SLE

“…Infections have been commonly implicated in lupus relapses and in some cases as initiating the diagnostic work up of systemic lupus erythematosus (SLE). A previously described association in literature is that of Salmonella typhi bacteremia and Cryptococcal neoformans meningitis occurring concurrently with the first presentation of SLE [1] , [2] , [3] . We describe here the case of a young patient who presented with Pseudomonas aeruginosa bacteremia and was diagnosed to have SLE.…”