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False-positive cerebrospinal fluid cryptococcus antigen in Libman-Sacks endocarditis

Iyad N Isseh1, Kassem Bourgi2, Asaad Nakhle2

  • 1Department of Internal Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA. iisseh1@hfhs.org.

Infection
|June 2, 2016
PubMed
Abstract

Insights

A false-positive cryptococcus antigen test occurred in a patient with lupus. Autoantibodies likely interfered, highlighting the need for careful interpretation of cryptococcal antigen tests.

Area of Science:

  • Neuroscience
  • Immunology
  • Infectious Diseases

Background:

  • Cryptococcus meningoencephalitis is a severe opportunistic infection in immunocompromised individuals, especially those with advanced AIDS.
  • Diagnosis relies on cerebrospinal fluid (CSF) cryptococcus antigen detection and cultures, with antigen testing being the preferred initial method due to its speed and accuracy.

Observation:

  • A case study involving a patient with systemic lupus erythematosus (SLE) presenting with acute confusion is presented.
  • Initial CSF analysis showed a positive cryptococcus antigen assay, but clinical symptoms did not align with cryptococcal meningoencephalitis.

Findings:

  • A repeat CSF evaluation three days later yielded a negative cryptococcus antigen assay.
  • The initial positive result is attributed to a false positive, likely caused by interference from autoantibodies, given the patient's active lupus and elevated antinuclear antibody titers.

Implications:

  • This case underscores the potential for false-positive results in CSF cryptococcus antigen assays due to autoantibody interference.
  • Clinicians should consider alternative diagnoses and repeat testing when clinical presentation is incongruent with laboratory findings, particularly in patients with autoimmune conditions.
Keywords:
Cryptococcus antigenCryptococcus meningoencephalitisLibman–Sacks endocarditisSystemic lupus erythematosus

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