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Cryptococcal Meningoencephalitis During Convalescence From Severe COVID-19 Pneumonia

Dharani Rohit Thota1, Bappaditya Ray1, Mirza Hasan2

  • 1Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA.

The Neurohospitalist
|December 24, 2021
PubMed

Insights

A rare case of invasive cryptococcal infection following severe coronavirus disease 2019 (COVID-19) pneumonia is reported. This invasive fungal infection occurred in a previously healthy patient and may be linked to COVID-19 treatments.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) can lead to severe pneumonia and respiratory failure.
  • Immunomodulatory therapies, including corticosteroids and tocilizumab, are used to manage severe COVID-19.
  • Invasive fungal infections are a known complication in immunocompromised individuals.

Observation:

  • A 76-year-old woman with severe COVID-19 pneumonia received remdesivir, convalescent plasma, corticosteroids, and tocilizumab.
  • Following recovery from COVID-19, the patient developed acute encephalopathy and multifocal ischemic strokes.
  • Cerebrospinal fluid (CSF) and blood cultures confirmed the presence of *Cryptococcus neoformans*.

Findings:

  • This case represents the first description of invasive cryptococcal infection complicating COVID-19 pneumonia in a previously immunocompetent patient.
  • The patient's presentation of encephalopathy and strokes was attributed to cryptococcal meningoencephalitis.
  • High-dose corticosteroid and tocilizumab treatment emerged as potential predisposing factors for the invasive fungal infection.

Implications:

  • Cryptococcal meningoencephalitis should be considered in the differential diagnosis of encephalopathy in patients with COVID-19.
  • The use of immunomodulatory agents in COVID-19 management may increase the risk of opportunistic fungal infections.
  • Further research is warranted to understand the interplay between COVID-19, its treatments, and invasive fungal infections.
Keywords:
COVID-19Cryptococcuscentral nervous system infectionsischemic strokemeningoencephalitistocilizumab

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