Cryptococcal neuroinfection in an adult patient with chronic B-lymphatic leukaemia with medium risk – a case report

Abstract

Summary Background Chronic B-lymphatic leukaemia is one reason for the development of secondary immunodeficiency due to a decrease of antibody immune activity (hypogammaglobulinaemia) and a decrease of T-cell immunity. Cryptococcosis is an infectious disease induced by Cryptococcus neoformans fungus. A high incidence was revealed in immunocompromised patients, above all in patients with AIDS or with haematological malignancies usually with a primary focus in the lungs and with characteristic spread into the cerebral dura mater and rarely into the kidneys, prostate, liver, bones and skin. Aim The aim of the study was to report a case of fatal Cryptococcus neoformans meningitis in an adult patient with chronic B-lymphatic leukaemia. Material/Methods It is a case study report of a 74-year-old man who presented with a four-year history of B-CLL admitted to the Department of Clinical Haematology with suspected neuroinfection. Symptoms included headache and sleepiness. Diagnostic work-up comprised neurological investigation, magnetic resonance imaging of the brain, lumbal puncture with microscopic, cytological and biochemical investigations of cerebrospinal fluid and investigations of blood serum for borellia, toxoplasma, Cytomegalovirus and Epstein-Barrs virus. Cultural investigation of the fluid verified two colonies of the fungus Cryptococcus neoformans. Despite intravenous and intrathecal administration of antibiotics and steroids the patient died due to septic shock. Conclusions Prognosis of cryptococcosis is very serious especially in immunocompromised patients and in the case of disseminated form is always infaust.