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Massive pleural effusions in cryptococcal meningitis
1Department of Medicine, University Hospital, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Abstract:
Cryptococcal infection uncommonly presents with pulmonary manifestations and even more rarely so as massive bilateral effusions. Pleural involvement is usually associated with underlying pulmonary parenchymal lesions and is unusual while on antifungal therapy. We report a patient with cryptococcal meningitis who, while on intravenous 5-flucytosine and amphotericin B, developed life-threatening bilateral massive pleural effusions with evidence of spontaneous resolution, consistent with prior hypothesis of antigenic stimulation as the cause of pleural involvement.
Insights
Massive bilateral pleural effusions from cryptococcal infection are rare, especially during antifungal treatment. This case suggests spontaneous resolution may occur, possibly due to antigenic stimulation.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Cryptococcal infections typically manifest as meningitis, with pulmonary involvement being uncommon.
- Pleural effusions in cryptococcal disease are rare and usually linked to parenchymal lung lesions.
- Pleural involvement during antifungal therapy for cryptococcosis is highly unusual.
Observation:
- A patient with cryptococcal meningitis developed severe, bilateral pleural effusions despite intravenous antifungal treatment.
- The patient was receiving 5-flucytosine and amphotericin B for cryptococcal meningitis.
- The massive pleural effusions showed signs of spontaneous resolution.
Findings:
- The case highlights an unusual presentation of cryptococcal infection with massive bilateral pleural effusions.
- Spontaneous resolution of these effusions was observed.
- This outcome supports the hypothesis that pleural involvement may be driven by antigenic stimulation.
Implications:
- This case expands the understanding of the clinical spectrum of cryptococcal disease.
- It suggests a potential mechanism (antigenic stimulation) for pleural effusion development and resolution in cryptococcosis.
- Further research may explore the role of immune responses in cryptococcal pleural effusions.