Disseminated Cryptococcosis Presenting with Adrenal Insufficiency and Meningitis: Resistant to Prolonged Antifungal Therapy but Responding to Bilateral Adrenalectomy.

Takeshita, Akira; Nakazawa, Hideki; Akiyama, Hiroshi; Takeuchi, Kazuo; Kawai, Ryuko; Oohashi, Kenichi; Shishiba, Yoshimasa

doi:10.2169/internalmedicine.31.1401

Cited by 23 publications

(18 citation statements)

References 19 publications

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“…Cryptococcosis of the central nervous system is life threatening and presents as meningitis or meningoencephalitis, with symptoms such as headache, increased intracranial pressure, fever, lethargy, coma, personality changes, and memory loss [4,9]. Other sites of hematogenous dissemination include skin, bones, joints, kidneys, adrenal gland, spleen, and prostate [7,10,11].…”

Section: Discussionmentioning

confidence: 99%

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Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host

Tabassum

Rahman

Herekar

et al. 2013

J Infect Dev Ctries

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Cryptococcosis is a potentially fatal fungal disease caused by variants of Cryptococcus neoformans species. The respiratory tract is the usual portal of entry, with a peculiar predilection to invade the central nervous system. The skin can be secondarily involved in disseminated infection or be exceptionally involved as primary cutaneous infection by inoculation. The disease is mostly seen in immunodeficiency states. The diagnosis is frequently unsuspected in immunocompetent patients. We report a case of disseminated cryptococcal meningitis in an immunocompetent young adult. The cutaneous eruption prompted the accurate diagnosis. The patient, a 20-year-old female, had fever, cough, headache and intractable vomiting for the past two months and was being managed as a case of tuberculous meningitis. Two weeks after starting antituberculous treatment she developed umbilicated papules on the head and neck region. Necessary laboratory workup identified C. neoformans in cerebrospinal fluid (CSF) and skin specimens. The titers of cryptococcal antigen were measured in CSF and serum for diagnostic and prognostic purposes. Anti-fungal treatment resulted in regression of the cutaneous lesions and resolution of systemic complaints. The case highlights the need for high degree of suspicion, especially in healthy young adults, in the diagnosis of cryptococcosis. The cutaneous eruptions can be the first manifestation or a diagnostic clue of enormous significance.

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Section: Discussionmentioning

confidence: 99%

“…Several authors have reported disseminated cryptococcosis being refractory to antifungal chemotherapy [6,19]. Serum antigen titers should be obtained in all immunocompetent patients who have cryptococcosis, to monitor the progress of the disease [20].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host

Tabassum

Rahman

Herekar

et al. 2013

J Infect Dev Ctries

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“…These data suggest that (1) prednisolone administered orally was not absorbed enough to suppress the ACTH release due to the protein-losing gastroenteropathy, (2) the patient was in a stressed condition with the disease, and/or (3) he had partial adrenal insufficiency. There are several case reports which have shown the development of adrenal insufficiency in patients with adrenal cryptococcosis, especially when accompanied by meningoencephalitis [5, 6, 11, 13, 21]. It is thus important to follow adrenal function serially in our patient, although he must continue prednisolone therapy for the underlying disease.…”

Section: Discussionmentioning

confidence: 98%

Normalization of Bilateral Adrenal Gland Enlargement after Treatment for Cryptococcosis

Muraoka

Iwama

Arima

2017

Case Reports in Endocrinology

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Cryptococcosis usually occurs in immunocompromised patients and can cause enlargement of the adrenal glands, although the morphologic changes after treatment have not been reported in detail. We report the case of 24-year-old man with fevers, headaches, and impaired consciousness who had been treated with glucocorticoids for a protein-losing gastroenteropathy. The cerebrospinal fluid analysis revealed cryptococcal meningitis. Computed tomography showed bilateral adrenal enlargement. A retrospective analysis revealed that the enlargement had been detected 5 months before admission and gradually increased. The enlargement was improved with antifungal therapy and normalized 6 months later. This is the first report describing morphological changes in the adrenal glands associated with cryptococcal meningitis. Adrenal enlargement by cryptococcosis can be improved without any abnormal findings, including calcifications, which may be a unique characteristic from other diseases, including tuberculosis.

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“…In contrast to tuberculosis and histoplasmosis, adrenal insufficiency is often improved with resolution of the disease. Adrenal cryptococcal infection resistant to antifungal therapy may respond to adrenalectomy [47]. …”

Section: Other Causes Of Adrenal Infectionsmentioning

confidence: 99%

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

Upadhyay

Sudhindra

Abraham

et al. 2014

International Journal of Endocrinology

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Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections.

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Disseminated Cryptococcosis Presenting with Adrenal Insufficiency and Meningitis: Resistant to Prolonged Antifungal Therapy but Responding to Bilateral Adrenalectomy.

Cited by 23 publications

References 19 publications

Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host

Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host

Normalization of Bilateral Adrenal Gland Enlargement after Treatment for Cryptococcosis

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

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