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Cryptoccocal menigitis as a primary manifestation in a patient with intestinal lymphangictasia

Shaik Afshan Jabeen1, Aruna Murthy, Rukmini Mridula Kandadai

  • 1Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.

Annals of Indian Academy of Neurology
|August 25, 2012
PubMed

Insights

Cryptococcal meningitis, a severe opportunistic infection, can occur in patients with primary intestinal lymphangiectasia (PIL). Early diagnosis and treatment of PIL are crucial for managing this potentially fatal condition.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Immunology

Background:

  • Opportunistic infections, such as cryptococcal meningitis, typically affect immunocompromised individuals.
  • Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by impaired lymphatic drainage in the small intestine, leading to protein-losing enteropathy and potential immune deficiencies.

Observation:

  • A case of cryptococcal meningitis in an immunocompetent adult patient is presented.
  • The patient exhibited lymphopenia, hypoalbuminemia, and hypogammaglobulinemia, with negative Human Immunodeficiency Virus (HIV) tests.
  • Diagnostic investigations revealed primary intestinal lymphangiectasia (PIL) as the underlying cause.

Findings:

  • Cerebrospinal fluid analysis confirmed cryptococcal meningitis via a positive latex agglutination test.
  • Gastrointestinal endoscopy and biopsy confirmed the diagnosis of primary intestinal lymphangiectasia (PIL).
  • The patient successfully responded to antifungal treatment with amphotericin B and flucytosine.

Implications:

  • Primary intestinal lymphangiectasia (PIL) should be considered in the differential diagnosis of cryptococcal meningitis, especially in patients with unexplained immune deficiencies and negative HIV tests.
  • Management requires a dual approach: aggressive antifungal therapy for meningitis and nutritional support for protein-losing enteropathy associated with PIL.
  • This case highlights the complex interplay between gastrointestinal disorders and opportunistic infections, emphasizing the need for a comprehensive diagnostic workup.
Keywords:
Cryptoccocal meningitiscellular and humoral immunityintestinal lymphangiectasia

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