Cryptococcal cerebellitis after chemotherapy and autologous stem cell re-infusion in a patient with multiple myeloma

Fickweiler, Ward; Aries, Marcel; Enting, Roeline; Vellenga, Edo; Keyser, de Jacques

doi:10.1007/s00415-009-0127-8

Cited by 9 publications

(18 citation statements)

References 7 publications

(5 reference statements)

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“…Asplenic individuals are at an increased risk for overwhelming sepsis due to encapsulated organisms that include Streptococcus pneumoniae , Hemophilus influenzae , Neisseria meningitidis , and certain other organisms such as Capnocytophaga canimorsus [ 7 – 9 ]. Two cases of cryptococcal meningitis causing cerebellitis have previously been reported, but cryptococcal meningitis has not previously been reported in asplenic individuals [ 10 , 11 ]. Clinical findings in cryptococcal cerebellitis are nonspecific, and radiology plays an essential role in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…In 2009, Fickweiler et al described a case of cryptococcal meningitis and cerebellitis that occurred following chemotherapy for multiple myeloma. [ 11 ]. The risk factors for the development of cryptococcal cerebellitis, its prognosis, and its response to treatment remain poorly understood [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 ]. The risk factors for the development of cryptococcal cerebellitis, its prognosis, and its response to treatment remain poorly understood [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Cryptococcal Meningitis and Cerebellitis in an Asplenic Patient, Seronegative for Human Immunodeficiency Virus (HIV)

et al. 2018

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Patient: Male, 65Final Diagnosis: Cryptococcal meningitisSymptoms: FeverMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Cryptococcal meningitis in patients who are seronegative for the human immunodeficiency virus (HIV) and in patients who are splenectomized is rare. This report is an unusual case of meningeal and cerebellar infection due to the encapsulated yeast, Cryptococcus neoformans, which has not previously been associated with asplenia.Case Report:A 65-year-old HIV-negative patient with a previous splenectomy, presented with a three-day history of fever, vomiting, and headache. His symptoms progressed to generalized body aches, persistent fever, and neck stiffness. A lumbar puncture was performed, and cerebrospinal fluid (CSF) culture grew Cryptococcus neoformans. Treatment commenced with intravenous amphotericin B and flucytosine. The patient required serial lumbar punctures due to persistent raised intracranial pressure (ICP). Magnetic resonance imaging (MRI) of the brain showed acute meningitis and cerebellitis. Antimicrobial therapy and CSF drainage resulted in clinical improvement.Conclusions:The occurrence of meningeal and cerebellar cryptococcosis in an asplenic patient is rare, and few cases have been previously reported. This case report highlights the possibility of invasive cryptococcal infection, or cryptococcosis, in asplenic individuals in the absence of HIV infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Cryptococcal Meningitis and Cerebellitis in an Asplenic Patient, Seronegative for Human Immunodeficiency Virus (HIV)

et al. 2018

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“…Currently, 24 cases of cryptococcosis in HSCT recipients have been reported in the English literature, with the first case reported in 1994 and the last in 2019 [ 7 – 27 ] ( Table 1 ). Although not always documented, leukemias (acute myelogenous, acute lymphoblastic, and myelodysplasia) [ 8 , 9 , 13 , 19 , 20 , 24 , 27 ], multiple myeloma [ 11 , 15 , 17 , 23 ], and lymphomas (Hodgkin disease and other lymphomas) [ 12 , 18 , 23 , 25 , 26 ] were the common haematological malignancies that were indications for HSCT, as reported worldwide [ 28 ]. From the patients with available data, 11 received allogeneic stem cell transplant, and 11 were autologous HSCT recipients.…”

Section: Clinical Casesmentioning

confidence: 99%

“…One patient presented cryptococcal meningitis followed by fungaemia [ 26 ], and another patient had disseminated cryptococcosis with renal involvement [ 20 ]. One case of cryptococcal cerebellitis [ 15 ] and one case of diarrhea [ 25 ], which are unusual presentations of cryptococcosis, were also reported. Symptoms before fungal diagnosis were very broad, including from fever, headache, vomiting, confusion, loss of consciousness, and hypertension to more complex and severe symptoms such as limb paresthesia, erythematous nodular rash, skin lesions, seizures, and even thrombotic microangiopathy.…”

Section: Clinical Casesmentioning

confidence: 99%

Cryptococcosis in Hematopoietic Stem Cell Transplant Recipients: A Rare Presentation Warranting Recognition

Firacative

Carvajal

Escandón

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Cryptococcosis, a life-threatening mycosis caused mainly by Cryptococcus neoformans, appears to be distinctly rare in hematopoietic stem cell transplant (HSCT) recipients. When it occurs, this fungal infection is a major limitation for a successful transplant. This review comprehensively analyses 24 cases, reported in the literature, of patients with haematological malignancies including leukemias, multiple myeloma, and lymphomas, as indication for HSCT, who presented with cryptococcosis after transplantation. Of the 24 cases, 11 each occurred in patients receiving allogeneic and autologous stem cell transplants, from bone marrow, peripheral blood, and umbilical cord blood. HSCT recipients were slightly more often male, and the age of the patients ranged from 12 to 74 years. Antifungal prophylaxis was reported in most cases. Clinical manifestations of cryptococcal disease included more frequently central nervous system involvement followed by fungaemia, disseminated infection, pulmonary cryptococcosis, cerebellitis, and diarrhea. Diagnosis differed depending on the clinical presentation but habitually included cryptococcal antigen assay, India ink, and culture. Notably, not only C. neoformans but also C. albidus, C. terreus, C. laurentii, and C. adeliensis were identified as the causal species, the last two including strains resistant to fluconazole. Amphotericin B, alone or in combination, was the most common antifungal drug used for the treatment of cryptococcosis in HSCT recipients. Due to the small number of cases, it was not possible to establish if mortality rate, which was the same as survival rate, depends on the effect of the immunosuppressive regimen, the site of cryptococcal infection, and/or the antifungal therapy used to control the mycosis. Although uncommon, the recognition of cryptococcal disease in stem cell transplant is essential for a timely and adequate treatment, improved prognosis, reduced morbidity and mortality, and successful transplantation.

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Yeast Infections After Haematopoietic Stem Cell Transplantation

Trubiano

Chen

Slavin

2016

Transplant Infections

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Cryptococcal cerebellitis after chemotherapy and autologous stem cell re-infusion in a patient with multiple myeloma

Cited by 9 publications

References 7 publications

A Rare Presentation of Cryptococcal Meningitis and Cerebellitis in an Asplenic Patient, Seronegative for Human Immunodeficiency Virus (HIV)

A Rare Presentation of Cryptococcal Meningitis and Cerebellitis in an Asplenic Patient, Seronegative for Human Immunodeficiency Virus (HIV)

Cryptococcosis in Hematopoietic Stem Cell Transplant Recipients: A Rare Presentation Warranting Recognition

Yeast Infections After Haematopoietic Stem Cell Transplantation

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