Disseminated Cryptococcosis Following Eculizumab Therapy: Insight Into Pathogenesis

Abstract

Eculizumab, a recombinant humanized monoclonal antibody (mAb), is used for the treatment of patients (both adults and children) with paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome (aHUS). This mAb binds to complement protein 5 (C5), thereby inhibits its cleavage. On the other hand, one of the C5 cleavage products C5a is a potent anaphylatoxin with proinflammatory properties, involved in antimicrobial surveillance. Administration of eculizumab has been reported to make patients more susceptible to infection by encapsulated bacteria. Here, we are reporting an adult case of disseminated infection due to the encapsulated yeast Cryptococcus neoformans following eculizumab therapy and discuss its pathogenesis.

Disseminated Cryptococcosis Post Eculizumab Therapy: A Case Report and Literature Review

“…The patients in the two previous cases were adult males [ 6 , 7 ], like in our case. Eculizumab was given to them for the treatment of atypical hemolytic uremic syndrome, while in our case, it was used for the management of myasthenia gravis.…”

“…The search aimed to identify any previous case reports of cryptococcal infection associated with the use of eculizumab, and two cases were found [6,7]. To our knowledge, this is the third case in the literature of a patient having a cryptococcal infection after being treated with eculizumab ( The patients in the two previous cases were adult males [6,7], like in our case. Eculizumab was given to them for the treatment of atypical hemolytic uremic syndrome, while in our case, it was used for the management of myasthenia gravis.…”

“…The search was performed using the keywords "eculizumab", “Cryptococcus”, “cryptococcosis”, and “cryptococcal”. The search aimed to identify any previous case reports of cryptococcal infection associated with the use of eculizumab, and two cases were found [ 6 , 7 ]. To our knowledge, this is the third case in the literature of a patient having a cryptococcal infection after being treated with eculizumab (Table 5 ).…”

“…Following the guidelines outlined by the advisory committee on immunization practices, it is recommended to vaccinate patients against Neisseria meningitidis before the initiation of eculizumab therapy [ 4 ]. The critical role of C5 against Cryptococcus neoformans infection has been shown in previous studies [ 5 ], and a limited number of disseminated cryptococcal infections following eculizumab have been reported [ 6 , 7 ]. Here, we present a case of disseminated cryptococcosis after eculizumab treatment.…”