Cryptococcal meningitis in patients with lupus nephritis.

Abstract

Cryptococcal meningitis (CM) is a rare condition in patients with lupus nephritis (LN). Here, we describe the clinical characteristics, possible risk factors, and outcomes of LN patients with CM. A systematic review of medical records from16 LN patients with CM admitted to our hospital was performed. A total of 32 cases were randomly selected as controls from LN patients without infection during the same period. The mean age of patients with CM at presentation was 35.1 years, and the female-to-male ratio was 15:1.The most common clinical manifestation was headache (93.7%); patients with CM had a significantly higher prednisone dose at the time of hospitalization, a higher SLE Disease Activity Index (SLEDAI), a higher urine protein/creatinine ratio, and a lower CD4+ T cells count than those without infection (p < 0.05). Patients with CM also had significantly higher activity index and more moderate and severe mesangial proliferation than those without infections (p < 0.001 and p = 0.025, respectively). Serious renal pathological changes, mass proteinuria, higher SLEDAI, higher prednisone dose, and a decline in CD4+ T cells could be risk factors for CM in patients with LN. Key Points ⦁ LN patients with CM had more serious renal pathological changes than those without infections; serious renal pathological changes could be a major risk factor for CM in patients with LN.