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Published on: May 2, 2017
Primary gastrointestinal lymphangiectasia presenting as cryptococcal meningitis
Steven L Cole1, Dennis K Ledford, Richard F Lockey
1Department of Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, James A. Haley Veterans' Hospital, Tampa, Florida 33612, USA. scole@health.usf.edu
Summary
This case study describes an adult with cryptococcal meningitis caused by intestinal lymphangiectasia, a rare condition. Early identification of immune dysfunction linked to this condition is crucial for timely treatment.
Area of Science:
- Gastroenterology and Immunology
- Infectious Diseases
Background:
- Opportunistic infections are common in immunocompromised individuals.
- Combined cellular and humoral immunodeficiency is rare in adults.
- Cryptococcal meningitis, often linked to cellular immunodeficiency, is fatal if untreated.
Observation:
- A 59-year-old male presented with disseminated cryptococcal meningitis and osteomyelitis.
- Diagnostic workup included laboratory tests, CT scans, and esophagogastroduodenoscopy with biopsy.
- Findings revealed lymphopenia, hypoalbuminemia, hypogammaglobulinemia, and intestinal lymphangiectasias.
Findings:
- The patient exhibited a rare combined immunodeficiency.
- Intestinal lymphangiectasias were identified as the underlying cause of immune dysfunction.
- Treatment with amphotericin B and flucytosine successfully resolved the cryptococcal meningitis.
Implications:
- This is the first reported case of cryptococcal meningitis secondary to intestinal lymphangiectasias.
- Clinicians should consider intestinal lymphangiectasias in adults presenting with lymphopenia, hypogammaglobulinemia, and hypoalbuminemia.
- Recognizing this association can lead to earlier diagnosis and management of immune dysfunction and opportunistic infections.
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