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Systemic lupus erythematosus complicated with cryptococcal meningitis: A case report
Honglei Ma1, Yuqun Wang1, Junhong Liu1
1Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, People's Republic of China.
Medicine
|April 14, 2023
Summary
Systemic lupus erythematosus patients with fever and headache may have cryptococcal meningitis. Early diagnosis via India ink stain and metagenomic sequencing, followed by empirical anti-infection therapy, is crucial for better outcomes.
Area of Science:
- Infectious Diseases
- Rheumatology
- Neurology
Background:
- Systemic lupus erythematosus (SLE) patients with cryptococcal meningitis (CM) are often misdiagnosed due to non-specific symptoms, potentially delaying critical treatment.
- Neuropsychiatric lupus and tuberculous meningitis are common differential diagnoses, highlighting the diagnostic challenge in SLE patients presenting with neurological symptoms.
Observation:
- A 40-year-old female with a 10-year history of SLE presented with acute onset of fever and headache.
- Cerebrospinal fluid (CSF) analysis revealed Cryptococcus neoformans via India ink stain, leading to a diagnosis of CM.
Findings:
- The patient received empirical antifungal therapy with amphotericin B and flucytosine.
- Significant clinical improvement was observed after 3 weeks of treatment.
Implications:
- Sudden headache and fever in SLE patients warrant consideration of CM.
- Early utilization of CSF India ink stain and metagenomic next-generation sequencing can aid in prompt microbial infection detection.
- Initiating empirical anti-infective treatment early in suspected cases can reduce mortality in SLE patients with CM.
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