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Cryptococcal meningitis presenting with isolated sixth cranial nerve palsy in a patient with systemic lupus

Seung-Ki Kwok1, Soo-Hong Seo, Ji Hyeon Ju

  • 1Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Journal of Korean Medical Science
|February 28, 2008
PubMed

Insights

Cryptococcal meningitis is a rare complication in patients with systemic lupus erythematosus (SLE). This case highlights a unique presentation and successful antifungal treatment for this challenging diagnosis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Rheumatology

Background:

  • Systemic lupus erythematosus (SLE) can present with diverse neuropsychiatric symptoms.
  • Cryptococcal meningitis is an opportunistic infection, rarely seen in SLE patients.
  • Differentiating CNS lupus from CNS infections can be diagnostically challenging.

Observation:

  • A male patient with a history of SLE presented with unilateral sixth cranial nerve palsy.
  • Neurologic findings were nonspecific, mimicking initial SLE manifestations.
  • Cerebrospinal fluid analysis confirmed the presence of Cryptococcus neoformans.

Findings:

  • The patient was diagnosed with cryptococcal meningitis superimposed on SLE.
  • Treatment with antifungal agents led to successful recovery.
  • The sixth cranial nerve palsy resolved with appropriate therapy.

Implications:

  • This case underscores the importance of considering opportunistic infections in SLE patients with new-onset neurological symptoms.
  • Early diagnosis and prompt antifungal treatment are crucial for favorable outcomes.
  • Recognizing atypical presentations like cranial nerve palsies can aid in timely diagnosis.

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