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Cryptococcal meningitis in HIV-negative patients with systemic connective tissue diseases
Cryptococcal meningitis (CM) in patients with systemic lupus erythematosus (SLE) often presents with delayed diagnosis due to overlapping symptoms. Prompt diagnosis and continued fluconazole treatment are crucial for managing this rare condition.
Area of Science:
- Infectious Diseases
- Rheumatology
- Neurology
Background:
- Cryptococcal meningitis (CM) is rare in non-HIV individuals.
- Systemic lupus erythematosus (SLE) patients may experience delayed CM diagnosis due to symptom overlap with immunological activity.
Purpose of the Study:
- To describe the natural history and outcomes of eight HIV-negative patients with SLE and confirmed CM.
- To highlight diagnostic challenges and treatment considerations for CM in SLE patients.
Main Methods:
- Retrospective case series analysis.
- Review of clinical manifestations, diagnostic workup (CSF analysis, MRI), and treatment outcomes.
- Assessment of laboratory parameters including lymphocyte and CD4+ cell counts.
Main Results:
- Headache, altered sensorium, and fever were common symptoms.
- Diagnosis was delayed by an average of 19 days.
- Patients exhibited lymphopenia and low CD4+ counts; 83% had active SLE and 87% had renal involvement.
- Cerebrospinal fluid cryptococcal antigen was positive in 90% of cases.
Conclusions:
- CM in SLE patients is linked to diagnostic delays and severe lymphopenia.
- Continued monitoring of CD4+ cell counts and maintenance fluconazole therapy are recommended until lymphopenia resolves.
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