Severe meningoencephalitis co-infection due to Cryptococcus neoformans and Mycobacterium tuberculosis in a child with systemic lupus erythematosus

Abstract

The incidences of infection with Mycobacterium tuberculosis and Cryptococcus neoformans in immunocompromised patients have increased, but there are few documented cases of their coexistence. We present the case of a 9-year-old female with systemic lupus erythematosus (SLE), treated with prednisone and cyclophosphamide, who was admitted to the emergency department with a 2-week history of fever, headache, malaise, fatigue, and diplopia 3 years after diagnosis. Physical examination showed limitation of abduction of the right eye, Kernig and Brudzinski signs, and hyporeflexia. Magnetic resonance imaging showed hyperdense lesions located in the caudate nucleus, and lumbar puncture showed pleocytosis, a low glucose level, and increased protein level. Cerebrospinal fluid culture identified C. neoformans and PCR detect M. tuberculosis. Treatment was started with isoniazid, rifampin, pyrazinamide, ethambutol, and amphotericin B. We found two similar reports in adults, but no data were found for either pediatric or SLE patients.

Pulmonary tuberculosis and Cryptococcal native knee septic arthritis with osteomyelitis in an immunocompetent patient: Mycobacterial effect on CD4 function and cellular immunity

“…Co-infection with cryptococcosis and tuberculosis is a rare but important phenomenon. This co-infection has been previously observed in an immunocompromised patient with systemic lupus erythematosus [12] . Our case demonstrates that immunocompetent hosts are also at risk for cryptococcal and tuberculosis co-infection.…”

Cyclophosphamide immunomodulation of TB-associated cerebral vasculitis

“…Although attractive in special situations, the use of cyclophosphamide in cerebral TB must be considered with caution. Reactivation of TB in subjects receiving cyclophosphamide has been reported, particularly in subjects with autoimmune disorders like LES [8,9]. On the other hand, it is in some way reassuring the evidence that cyclical chemotherapy with regimens containing cyclophosphamide does not lead to reactivation of tuberculosis [10].…”

Multiplex detection of meningitis and encephalitis pathogens: A study from laboratory to clinic

“…We also reported MTB and CN co-infection in southwestern China, which has not been shown by a systematic review while the review concludes that the co-infections of MTB and CN were more popular in southern and eastern China (31). Poly-infections remind clinicians to adjust medications and treatment duration, differing from mono-infections (32)(33)(34). The detection of co-infections by MME-18 implies its value in detecting unexpected pathogens that clinicians may ignore due to indistinguishable manifestations or individual variations.…”