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Corticosteroid-induced cryptococcal meningitis in patient without HIV
Anand Nidhi1, Alpana Meena2,3, Arjun Sreekumar1
1Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India.
BMJ Case Reports
|January 6, 2017
Summary
High-dose steroid therapy can lead to cryptococcal meningitis, even in young patients. This case highlights the risk of fungal infections in individuals undergoing steroid treatment for conditions like tubercular meningitis.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Cryptococcus neoformans is a significant cause of fungal meningitis globally, affecting individuals across all age groups.
- It is a common opportunistic infection in individuals with advanced HIV/AIDS (CD4 counts <100/mm³).
- Susceptibility to fungal infections can arise from various forms of immunosuppression, including chronic high-dose steroid use.
Observation:
- This report details a 14-year-old boy who developed cryptococcal meningitis after an 8-week course of steroid treatment for tubercular meningitis.
- The patient was apparently immunocompetent prior to steroid therapy.
Findings:
- The study highlights a potential association between prolonged steroid therapy and the development of cryptococcal meningitis.
- This case underscores that even individuals without overt immunosuppression can develop severe fungal infections when treated with steroids.
Implications:
- Clinicians should consider cryptococcal meningitis in patients with a history of steroid therapy, particularly those being treated for conditions like tubercular meningitis.
- Increased vigilance is warranted for steroid-associated fungal infections, necessitating prompt diagnosis and management.
- Further research may be needed to elucidate the precise mechanisms and risk factors associated with steroid-induced susceptibility to Cryptococcus.
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