Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

Sakiyama, Yusuke; Matsuura, Eiji; Shigehisa, Ayano; Hamada, Yuki; Dozono, Mika; Nozuma, Satoshi; Nakamura, Tomonori; Higashi, Keiko; Hashiguchi, Akihiro; Takahashi, Yukitoshi; Takashima, Hiroshi

doi:10.2169/internalmedicine.4629-20

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…In contrast, in patient 9, who showed delayed exacerbation, anti-NMDAR antibodies were detected before antifungal treatment. The coexistence of cryptococcal meningitis and anti-NMDAR antibody encephalitis has been reported previously (18)(19)(20); however, the pathogenesis of autoim-mune encephalitis remains unclear. Taken together, these reports suggest that autoantibodies may be one mechanism underlying the delayed exacerbation of cryptococcal meningitis.…”

Section: Discussionmentioning

confidence: 98%

Clinical Characteristics of Patients with Cryptococcal Meningitis in Hokkaido: A Case Series

Tarisawa,

Kano,

Ishimaru

et al. 2024

Intern. Med.

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We retrospectively reviewed the medical histories, examination results, treatments, and prognoses of nine patients with cryptococcal meningitis who were diagnosed and treated at Hokkaido University Hospital and its affiliated hospitals over the past 10 years. Cryptococcal meningitis can develop even in immunocompetent hosts, and its prognosis is poor owing to diagnostic difficulties and delayed treatment. Although liposomal amphotericin B and oral 5-fluorocytosine are standard therapies, voriconazole or intraventricular administration of amphotericin B may also be considered treatment options for refractory patients. Some patients develop delayed exacerbations owing to immunological mechanisms that require steroid therapy.

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Section: Discussionmentioning

confidence: 98%

Clinical Characteristics of Patients with Cryptococcal Meningitis in Hokkaido: A Case Series

Tarisawa,

Kano,

Ishimaru

et al. 2024

Intern. Med.

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“…Recently, a case mimicking NMDAR encephalitis was reported in which the patient presented with bilateral ptosis and external ophthalmoplegia and MDs of the face and limbs, but these manifestations were persistent and occurred simultaneously ( 19 ). In addition, a few cases were accompanied by limb tremors, but none were specific ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Anti-NMDA receptor encephalitis manifesting as rapid weight loss and abnormal movement disorders with alternating unilateral ptosis and contralateral limb tremor

et al. 2022

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, associated with immunoglobulin G (IgG) autoantibodies against the GluN1 subunit of the NMDAR, is one of the most common types of autoimmune encephalitis. In patients with anti-NMDAR encephalitis, movement disorders (MDs) are often frequent, mainly presenting as facial dyskinesias and stereotyped movements. The alternating clinical manifestation of limb tremor with unilateral ptosis is rare. Here, we report an interesting case of a 22-year-old woman with rapid weight loss presenting with staged dyskinesia. Interestingly, she typically showed persistent tremor of the right upper limb, which would stop when her left upper eyelid drooped uncontrollably, a phenomenon that lasted for a few seconds, followed by automatic upper eyelid lift and continued persistent tremor of the upper limb. Moreover, it was fortunate to find anti-NMDAR antibodies in her cerebrospinal fluid (CSF), which indicated the patient had anti-NMDAR encephalitis. And abnormal apparent diffusion coefficient (ADC) hyperintense signals on the left midbrain interpeduncular fossa explained this manifestation of focal neurological deficit. After the systematic administration of immunotherapy (intravenous immunoglobulin, IVIG), steroid pulse therapy, and symptomatic treatment, the initial symptoms were significantly relieved except for limb tremor. The MDs were becoming less visible for the next six months under topiramate prescriptions. Noteworthy, there are no specific MD phenotypes in anti-NMDAR encephalitis. We describe the young women with unique MDs and rapid weight loss to help us get a more comprehensive understanding of anti-NMDAR encephalitis.

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“…Of these more recently described processes, herpes simplex virus encephalitis (HSVE) is the most commonly associated 4,5 . Other infectious triggers have also been identified including varicella zoster infection, 6 cryptococcal meningitis 7 and HIV, 8 and anti‐NMDA‐R antibodies have also been described in other disease states such as neuromyelitis optica 9 and melanoma 10 …”

Section: Introductionmentioning

confidence: 99%

“…3 Of these more recently described processes, herpes simplex virus encephalitis (HSVE) is the most commonly associated. 4,5 Other infectious triggers have also been identified including varicella zoster infection, 6 cryptococcal meningitis 7 and HIV, 8 and anti-NMDA-R antibodies have also been described in other disease states such as neuromyelitis optica 9 and melanoma. 10 Armangue and colleagues reported a prospective study in which autoimmune encephalitis occurred in 27% of patients with HSVE and emphasised the need for prompt diagnosis as even when triggered by HSVE, anti-NMDA-R encephalitis can respond to immunosuppressive/immunomodulatory therapy.…”

Section: Introductionmentioning

confidence: 99%

Analysing triggers for anti‐NMDA‐receptor encephalitis including herpes simplex virus encephalitis and ovarian teratoma: results from the Queensland Autoimmune Encephalitis cohort

Swayne

Warren

Prain

et al. 2022

Internal Medicine Journal

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Background: Anti-N-methyl-D-aspartate-receptor (anti-NMDA-R) encephalitis is a complex autoimmune neuropsychiatric syndrome. Although initially associated with ovarian teratoma, subsequent studies have demonstrated that anti-NMDA-R encephalitis may occur without an identifiable cause or be triggered by viral infection of the central nervous system such as herpes simplex virus encephalitis (HSVE).Aim: To present details from a Queensland cohort analysing triggering events in patients with anti-NMDA-R encephalitis in an Australian context. Methodology:The authors identified patients with anti-NMDA-R encephalitis diagnosed and managed through public hospitals in Queensland, Australia, between 2010 and the end of 2019. Data collected included demographics, clinical presentation, investigation results, management and outcome measurements.Results: Thirty-one cases of anti-NMDA-R encephalitis were included in the study.Three cases of anti-NMDA-R encephalitis were triggered by prior HSVE, five cases were associated with ovarian teratoma and 23 cases had no identifiable trigger. There were an additional three cases in which anti-NMDA receptor antibodies were present in the context of other disease states but where the patient did not develop anti-NMDA-R encephalitis. Cases triggered by HSVE or associated with ovarian teratoma experienced a more severe disease course compared to cases with no identifiable trigger. All groups responded to immunosuppressive or immunomodulatory therapy. Analysis of clinical characteristics revealed a complex heterogeneous syndrome with some variability between groups. Conclusion:In this cohort, the number of cases of anti-NMDA-R encephalitis triggered by HSVE is comparable to those triggered by ovarian teratoma. However, the majority of cases of anti-NMDA-R encephalitis had no identifiable trigger or associated disease process.

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Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

Cited by 8 publications

References 13 publications

Clinical Characteristics of Patients with Cryptococcal Meningitis in Hokkaido: A Case Series

Clinical Characteristics of Patients with Cryptococcal Meningitis in Hokkaido: A Case Series

Case report: Anti-NMDA receptor encephalitis manifesting as rapid weight loss and abnormal movement disorders with alternating unilateral ptosis and contralateral limb tremor

Analysing triggers for anti‐NMDA‐receptor encephalitis including herpes simplex virus encephalitis and ovarian teratoma: results from the Queensland Autoimmune Encephalitis cohort

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