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Fulminant cryptococcal meningoencephalitis after successful treatment of primary cutaneous cryptococcosis
Iordanis Romiopoulos1, Zoi Dorothea Pana2, Athina Pyrpasopoulou3
1MD, Infectious Diseases Unit, Hippokration Hospital, 54642 Thessaloniki, Greece.
Insights
This case highlights a rare instance of cryptococcal meningoencephalitis in an immunocompetent individual, occurring years after a primary skin infection. It underscores the potential for delayed, severe central nervous system disease from Cryptococcus neoformans.
Area of Science:
- Infectious Diseases
- Neurology
- Mycology
Background:
- Cryptococcal meningoencephalitis (CM) is a severe fungal infection primarily impacting immunocompromised individuals.
- Cryptococcus neoformans is the causative agent, often presenting as a serious central nervous system infection.
Observation:
- A 64-year-old immunocompetent male developed a scalp infection with C. neoformans, treated successfully with fluconazole and liposomal amphotericin B.
- Two years later, during cancer chemotherapy, the patient presented with fulminant CM, unresponsive to standard antifungal therapy.
Findings:
- This report details the first known case of fulminant CM with a long latency period after a primary cutaneous infection.
- The patient's immunocompetence and the delayed, severe CNS manifestation present a unique clinical challenge.
Implications:
- This case suggests that even immunocompetent individuals can develop severe, latent cryptococcal infections.
- It emphasizes the need for vigilance and consideration of C. neoformans in CNS infections, regardless of host immune status or prior infection history.
- Further research into the pathogenesis of latent C. neoformans infections and treatment strategies for refractory CM is warranted.
Introduction:
Cryptococcal meningoencephalitis is a life-threatening disease affecting mainly immunocompromised hosts.
Case Report:
We present a case of a 64-year-old immunocompetent patient, who initially developed a traumatic scalp skin infection due to Cryptococcus neoformans. The patient received oral fluconazole and subsequently liposomal amphotericin B due to the development of resistance with resolution of the infection. Two years later, during chemotherapy for newly diagnosed gastric and lung cancer, he developed fulminant cryptococcal meningoencephalitis, which did not respond to liposomal amphotericin B and flucytosine.
Conclusions:
To our knowledge, this is the first case of fulminant cryptococcal meningoencephalitis following long latency after adequately treated primary cutaneous infection.
