Cryptococcal meningitis in systemic lupus erythematosus—Magnetic resonance imaging is not good (original) (raw)

An unusual case of inflammatory meningitis in a young man with systemic lupus erythematosus

Lupus, 2018

We describe a man presenting with unusual neurological manifestations of systemic lupus erythematosus (SLE) including pachymeningitis, aseptic meningitis and encephalitis with grossly elevated cerebrospinal fluid protein, responding to immunosuppression. Initially he had intermittent dysarthria, dysphasia and unilateral upper limb weakness. One month later he experienced dysphasia, right-sided hemiparesis and confusion. Cerebrospinal fluid (CSF) analysis showed a white cell count of 70 x 106/litre and an unusually elevated protein level of 5.39 g/litre. An MRI brain showed dural and leptomeningeal enhancement compatible with a meningitic process. He improved with cefotaxime and aciclovir. On day seven of antimicrobials he developed left-sided weakness, sensory inattention and a left homonymous hemianopia. He responded well to intravenous methylprednisolone. On switching to oral prednisolone he developed expressive dysphasia, a right inferior quadrantanopia and seizures. His bloods w...

Concurrent presentation of cryptococcal meningoencephalitis and systemic lupus erythematosus

Modern Rheumatology, 2011

Cryptococcal meningitis is a recognized complication of systemic lupus erythematosus (SLE), with high mortality rates, particularly in those treated with immunosuppressive agents. We describe a patient diagnosed simultaneously with cryptococcal meningoencephalitis and SLE and reviewed four similar cases reported in the literature. In our case, profound low CD4 lymphocyte count and low complement levels were observed. The patient was treated with prednisolone, fluconazole, and 5-flucytosine and evinced good clinical improvement. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections.

Cryptococcal meningitis in systemic lupus erythematosus

Seminars in Arthritis and Rheumatism, 1992

Two cases of cryptococcal meningitis occurring in patients with systemic lupus erythematosus (SLE) are presented, and 24 additional cases from the literature are reviewed. The insidious onset of this infrequent complication is emphasized. The nonspecific neurological findings associated with this infection are often mistakenly diagnosed as a central nervous system manifestation of SLE. Earlier diagnosis and effective

Cryptococcal meningitis in steroid-treated systemic lupus erythematosus

Postgraduate Medical Journal, 1975

A case of cryptococcal meningitis complicating steroidtreated systemic lupus erythematosus (SLE) which was successfully treated with amphotericin B is described. Although apparently rare, this mycotic infection has been reported from six patients with SLE in the medical literature over the past 10 years. Four of the six had been treated with steroids for periods ranging from 10 weeks to 6 years. In only one of these was the fungal infection diagnosed and effectively treated. Because effective therapy is available it is imperative that cryptococcal meningitis be not confused with progressive central nervous system involvement of SLE.

Central nervous system infections in patients with systemic lupus erythematosus

The Journal of rheumatology, 2005

To evaluate the clinical profiles of patients with systemic lupus erythematosus (SLE) with central nervous system (CNS) infections. We retrospectively reviewed patients with SLE with CNS infections from January 1983 to June 2003. The clinical features, laboratory data, and prognoses of these patients were recorded. During the 20-year review period, 17 SLE patients with CNS infections were identified. The mean age at CNS infection was 29.6 +/- 15.3 years. Cryptococcal infection was identified in 10 patients and bacterial meningitis in 7. Most patients (94%) had active SLE at the time of CNS infection. Fifteen patients received corticosteroid therapy and of these, 7 received it in conjunction with immunosuppressive agents. The most common presentation was headache, fever, and vomiting. The mortality rate among the 17 patients was high (41.2%). Cryptococcal meningitis played the major role in CNS infection of patients with SLE, and it cannot be ruled out even when the cerebrospinal flu...

Cryptococcal meningitis and SLE: a diagnostic and therapeutic challenge

A previously healthy 13-year-old girl was diagnosed with SLE in May 2012 when she presented with alopecia, malar rash, arthralgia in the hand and knee joints, hypocomplementaemia, positive antinuclear antibody and a highly positive anti-dsDNA (1141 IU/ml). She achieved rapid improvement with 25 mg of oral prednisolone (0.5mg/kg/day) and 200 mg of hydroxychloroquine (HCQ) daily (3.5mg/kg/day). Five months later when her prednisolone was tapered to 10 mg daily, she developed bilateral lower limb oedema and frothy urine. During hospitalisation, investigations revealed significant proteinuria (5.31g/24hr) and WHO class IVa lupus nephritis. She received 500 mg of intravenous (IV) methylprednisolone daily for three days and was then maintained on 25 mg of prednisolone daily (0.5 mg/kg/day).

Chronic meningitis in systemic lupus erythematosus: An unusual etiology

Annals of Indian Academy of Neurology, 2014

Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus (SLE). Apart from immunological causes and drugs, the aseptic meningitis group can include some unidentified viral infections that cannot be detected by routine microbiological testing. It is imperative to do complete cerebrospinal fluid (CSF) workup before implicating the symptoms to disease activity or drugs, as untreated infections cause significant mortality in SLE. We present a case of young female with SLE who presented with chronic meningitis of an uncommon etiology.

Acute meningoencephalitis in a patient with systemic lupus erythematosus

Military Medical and Pharmaceutical Journal of Serbia, 2013

Introduction. Infections in patients with systemic lupus erythematosus (SLE) are a significant factor of morbidity and mortality. Although central nervous system infections, including septic meningitis, are rare in patients with SLE, they can be significant causes of mortality inspite of the prompt and accurate diagnosis and proper management. Case report. We presented a woman with the diagnosis of SLE and diffuse proliferative lupus nephritis. Because of disease activity we introduced cytostatic immunosuppressive therapy, cyclophosphamide and then azathioprine. Meningoencephalitis, staphylococcal sepsis and abscess of the brain, with resulting seizures developed. Conclusion. This case alerts to the need of careful examination of patients with SLE, collection of adequate cultures and evaluation of predisposition towards ifnections, before the introduction of immunosuppressants due to potentially fatal infection.