J Korean Rheum Assoc.  2010 Jun;17(2):194-199. 10.4078/jkra.2010.17.2.194.

A Case of Disseminated Crytococcosis in a Patient with Systemic Lupus Erythematosus

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea. heeya0035@cu.ac.kr
  • 2Arthritis and Autoimmunity Research Center, Catholic University of Daegu, Daegu, Korea.

Abstract

Disseminated cryptococcosis mainly occurs in immunocompromised patients. It enters the body through the respiratory tract and spreads to the lungs, skin, liver and lymphoid organs. Among cryptococcosis, cryptococcal meningitis is a relatively frequent manifestation and causes serious morbidity and mortality. It needs urgent diagnosis and initiation of effective antifungal therapy. It is difficult to differentiate cryptococcal meningitis from neuropsychiatric lupus due to similar clinical symptoms, laboratory and cerebrospinal fluid findings. We report a case of disseminated cyrptococcosis in a patient with systemic lupus erythematosus being managed with mycophenolate mofetil, prednisolone and hydroxychloroquine.

Keyword

Disseminated cryptococcosis; Systemic lupus erythematosus

MeSH Terms

Cryptococcosis
Humans
Hydroxychloroquine
Immunocompromised Host
Liver
Lung
Lupus Erythematosus, Systemic
Meningitis, Cryptococcal
Mycophenolic Acid
Prednisolone
Respiratory System
Skin
Hydroxychloroquine
Mycophenolic Acid
Prednisolone

Reference

1). Galdman DD., Hussain F., Ibanez D., Urowitz MB. The nature and outcome of infection in systemic lupus erythematosus. Lupus. 2002. 11:234–9.
Article
2). Van der Horst CM., Saag MS., Cloud GA., Hamill RJ., Graybill JR., Sobel JD, et al. Treatment of cryptococcal meningitis associated with acquired immunodeficiency syndrome. N Engl J Med. 1997. 337:15–21.
3). Shin CC., Chen YC., Chang SC., Luh KT., Hsieh WC. Cryptococcal meningitis in non-HIV-infected patients. QJM. 2000. 93:245–51.
4). Lee CW., Song SH., Bae WH., An JH., Kim SI., Kim MK, et al. A case of cryptococcal meningitis in a patient with systemic lupus erythematosus. J Korean Rheum Assoc. 1999. 6:346–50.
5). Kwok SK., Seo SH., Ju JH., Yoon CH., Park SC., Kim BS, et al. Cryptococcal meningitis presenting with isolated sixth cranial nerve palsy in a patient with systemic lupus erythematosus. J Korean Med Sci. 2008. 23:153–5.
Article
6). Kim SH., Kim SD., Kim HR., Yoon CH., Lee SH., Kim HY, et al. Intraabdominal cryptococcal lymphadenitis in a patient with systemic lupus erythematosus. J Korean Med Sci. 2005. 20:1059–61.
Article
7). Kang I., Park SH. Infectious complication in SLE after immucosuppressive therapies. Curr Opin Rheumatol. 2003. 15:528–34.
8). Malabonga VM., Basti J., Kamholz SL. Utility of bronchoscopic sampling techniques for cryptococcal disease in AIDS. Chest. 1991. 99:370–2.
Article
9). Zimmermann B., Spiegel M., Lally EV. Cryptococcal meningitis in systemic lupus erythematosus. Semin Arthritis Rheum. 1992. 22:18–24.
Article
10). Saha DC., Xess I., Biswas A., Bhowmik DM., Padma MV. Detection of cryptococcus by conventional, serological and molecular methods. J Med Microbiol. 2009. 58:1098–105.
Article
11). Michael S., Richard J., Robert A., Pappas PG., John R., William G, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2000. 30:710–9.
12). Sebetta JM., Andriole VT. Cryptococcal infection of the central nervous system. Med Clin North Am. 1985. 69:333–45.
13). Saag MS., Graybill RJ., Larsen RA., Pappas PG., Perfect JR., Powderly WG, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2000. 30:710–8.
Article
14). Pappas PG., Chetchotisakd P., Larsen RA., Manosuthi W., Morris MI., Anekthananon T, et al. A phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Clin Infect Dis. 2009. 48:1775–83.
Article
15). Kim HJ., Park YJ., Kim WU., Park SH., Cho CS. Invasive fungal infections in patients with systemic lupus erythematous: experience from affiliated hospitals of Catholic University of Korea. Lupus. 2009. ;18;661-6.
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