Abstract
Cryptococcus neoformans infections occur mostly in immunodeficient individuals, being the most common opportunistic fungal central nervous system (CNS) infection in HIV seropositive patients. Moreover, other conditions affecting host immunity, such as hematologic malignancies, organ transplantation and immunosuppressive drugs are implicated as risk factors. The authors present a case of a 48-year-old male with Hodgkin Lymphoma for 26 years and submitted to several lines of treatment, diagnosed with cryptococcal meningitis while on therapy with brentuximab. The patient presented with positive cerebral spinal fluid (CSF) cryptococcal antigen plus positive blood cultures. He was put under induction antifungal treatment with liposomal amphotericin B and flucytosine, as well as corticosteroid therapy with dexamethasone with headache improvement and a favorable clinical evolution. There are no reported cases of cryptococcal meningoencephalitis under CD30-directed monoclonal antibody. Furthermore, this case illustrates the risk of Cryptococcus neoformans infection in immunocompromising conditions other than HIV, underlining the need of considering this differential diagnosis when physicians face an opportunistic neuroinfection.
Highlights
Cryptococcus species have a major predilection for the lungs with potential to spread further, mainly through continuity or through hematogenic and lymphoid pathways, with possible penetration through the blood-brain barrier and central nervous system (CNS) involvement[1,2,3,4].Cryptococcus neoformans infections occur mostly in immunodeficient individuals, being the most common opportunistic CNS infection in HIV-positive patients, counting up to 1 million new infections annually worldwide[3,4]
Any further responses from the reviewers can be found at the end of the article one autologous bone marrow transplant in 1998, as well as an allogenic stem cell transplant in 2001, followed by several lines of chemotherapy
C ryptococcal meningitis diagnosis may be challenging in cases presenting negative cerebral spinal fluid (CSF) cultures, but cryptococcal polysaccharide antigen titers in CSF correlate with fungal burden
Summary
Any reports and responses or comments on the article can be found at the end of the article. As suggested by the peer review reports, grammar corrections have been made in this new version. Any further responses from the reviewers can be found at the end of the article one autologous bone marrow transplant in 1998, as well as an allogenic stem cell transplant in 2001, followed by several lines of chemotherapy. Learning points C ryptococcal meningitis is a common opportunistic central nervous system (CNS) infection among HIVpositive patients. E very immunocompromising condition must be assessed and considered a risk factor for an opportunistic fungal meningoencephalitis. C ryptococcal meningitis diagnosis may be challenging in cases presenting negative cerebral spinal fluid (CSF) cultures, but cryptococcal polysaccharide antigen titers in CSF correlate with fungal burden
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