Cryptococcus neoformans meningoencephalitis in a patient with polyarteritis nodosa

Case of 59-year-old male with chronic obstructive pulmonary disease and a number of comorbidities, who has developed meningoencephalitis caused by Cryptococcus neoformans var. grubii with polyarteritis nodosa diagnosed during hospitalization, was presented. Before evidence of meningoencephalitis, th...

Full description

Saved in:
Bibliographic Details
Published in:Folia microbiologica 2014-11, Vol.59 (6), p.515-521
Main Authors: Buchta, Vladimír, Prášil, Petr, Vejsová, Marcela, Mottl, Roman, Kutová, Radka, Drahošová, Marcela, Plíšek, Stanislav
Format: Article
Language:English
Subjects:
amphotericin B
Antifungal Agents - administration & dosage
antigens
Applied Microbiology
Bacterial diseases
bacterial infections
Biomedical and Life Sciences
blood
candidiasis
Chronic obstructive pulmonary disease
comorbidity
cryptococcosis
Cryptococcus neoformans
Cryptococcus neoformans - drug effects
Cryptococcus neoformans - genetics
Cryptococcus neoformans - isolation & purification
early diagnosis
encapsulation
Encephalitis
Environmental Engineering/Biotechnology
Fatal Outcome
fluconazole
Fluconazole - administration & dosage
Fungal infections
Health risks
Humans
Immunology
intravenous injection
ketoconazole
latex agglutination test
Life Sciences
Male
males
Medical treatment
meningoencephalitis
Meningoencephalitis - drug therapy
Meningoencephalitis - etiology
Meningoencephalitis - microbiology
Microbiology
Middle Aged
Nosocomial infection
patients
Polyarteritis Nodosa - complications
Polyarteritis Nodosa - microbiology
Risk factors
sequence analysis
therapeutics
vasculitis
Yeasts
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Case of 59-year-old male with chronic obstructive pulmonary disease and a number of comorbidities, who has developed meningoencephalitis caused by Cryptococcus neoformans var. grubii with polyarteritis nodosa diagnosed during hospitalization, was presented. Before evidence of meningoencephalitis, the patient was being treated with ketoconazole and low doses of fluconazole (200 mg/day) for alleged candidiasis. The dosage was increased (800 mg/day) following laboratory diagnosis of C. neoformans based on positive latex agglutination test and biochemical identification of encapsulated yeast isolated from the blood and CSF. Later, the yeast identification was confirmed by sequencing analysis. Owing to inadequate clinical response, fluconazole therapy was switched to voriconazole (400 mg/day) and later to intravenous amphotericin B (1.0 mg/kg per day). Despite of a temporary stabilization and improvement, which correlated with decline of cryptococcal antigen titers (from 1:1024 to 1:8), after 6 weeks, the patient’s underlying condition deteriorated due to severe pancolitis and serious nosocomial bacterial infections. The patient died of multiorgan failure several days later. Our case demonstrates a possible connection between the development of life-threatening cryptococcosis and an autoimmune vasculitis disease and emphasizes that the outcome of the management of cryptococcal meningoencephalitis is highly dependent on early diagnosis, adequate treatment, including dosage, and last but not least control of underlying disease and risk factors.
ISSN:0015-5632
1874-9356
DOI:10.1007/s12223-014-0328-0