Clinical and Laboratory Characteristics of Cryptococcal meningitis in Patients with Systemic Lupus Erythematosus

Abstract

Objective: Patients with systemic lupus erythematosus (SLE) are prone to develop opportunistic infections. Cryptococcal infection, particularly meningitis, frequently develops insidiously and is associated with high mortality if there is delayed diagnosis or inappropriate antifungal therapy. The aim of this study was to describe the clinical, laboratory and serological features of 11 SLE patients with cryptococcal meningitis.Methods: In total, 2036 patients, who fulfilled the diagnosis criteria for SLE, were hospitalized in Taichung Veterans General Hospital. Eleven patients were diagnosed as cryptococcal meningitis according to cerebrospinal fluid (CSF) analysis.Results: Of the 11 patients, 10 (90.9%) patients had fever, 7 (63.9%) patients had headache, but only 2 (18.2%) patients had meningeal signs. At the time of investigation, all patients were in lymphopenic status, only 33% (3/9) of patients had elevated levels of serum C-reactive protein, and 45% (5/11) of patients had a low leukocyte count (＜10/mm3) in CSF. The mean value of CSF protein was 95 mg/dL. Eighty-percent (8/10) of patients had elevated IgG index in CSF, while 83.3% (5/6) of patients had positive oligoclonal band. The positive rate for the latex agglutination test for cryptococcal antigen was 100% in CSF. The India ink stain was 81.8% positive and Cryptococcus neoformans was obtained in 81.8% of CSF cultures. All patients underwent corticosteroid treatment and most patients received immunosuppressants including cyclophosphamide, hydroxychloroquine, and azathioprine. The most common clinical manifestations of cryptococcal meningitis in our SLE patients were fever and headache; however, meningeal signs were rare. Lymphopenia seems to be a risk factor for cryptococcal meningitis.Conclusion: The clinical presentation of cryptococcal meningitis in SLE patients is non-specific and the cell count in CSF may be normal. Cryptococcal meningitis should be taken in mind in SLE patients under lymphopenic status with fever of headache.