A Case of Multiple Myeloma Presenting as <b><i>Streptococcus pneumoniae</i></b> Meningitis with <b><i>Candida auris</i></b> Fungemia

Abstract

Multiple myeloma (MM), a plasma cell neoplasm, has a typical presenting pattern consisting of bone pain, renal failure, anemia, and/or hypercalcemia. Even though MM is a cancer that impairs the immune system, rarely is a systemic infection the first sign of disease. In this case report, our patient presented with altered mental status due to meningitis and was later diagnosed with MM. Furthermore, we display a case of a rare but emerging and serious fungus, Candida auris, that the patient developed during his inpatient stay. This is the first such record of C. auris in an MM patient.

Impact of Candida auris Infection in a Neutropenic Murine Model

“…Torticollis and other changes in behavior were not observed with inocula of 10 5 and 10 6 cells. While these changes have not been reported for humans, two clinical studies described patients admitted with altered mental status and unsteady gait (20,24). However, there was no…”

“…(H) The C. auris output in urine was found to be 10 2 CFU/l. clear indication whether this was due to C. auris infection, and this is an area in which further studies are needed (20,24). Although C. auris microabscesses were present in the brain, they were not present in the cerebellum, an area important for balance and coordination; therefore, further studies will need to be performed to address the pathology of the inner ear.…”

Impact of Candida auris infection in a neutropenic murine model

“…Interestingly, we noted that between 8-13 days post C. auris infection, mice displayed a unique behavioral phenotype characterize by torticollis and tail spinning when elevated and that this phenotype can progress to head bobbing, erratic fast movements and body curling by day 22 post infection. While these changes have not been reported in humans, two clinical studies described patients admitted with altered mental status and unsteady gait (14, 18). However, there was no clear indication whether this was due to C. auris infection and this is an area where further studies are needed (14, 18).…”

“…While these changes have not been reported in humans, two clinical studies described patients admitted with altered mental status and unsteady gait (14, 18). However, there was no clear indication whether this was due to C. auris infection and this is an area where further studies are needed (14, 18). Although C. auris microabsesses were present in the brain, it was not present in the cerebellum an area important in balance and coordination therefore, further studies will need to be done to address the pathology of the inner ear.…”

“…In two case studies, 72 and 74- year old patients were admitted with alteration of mental status and unsteady gait. However, there was no clear indication whether this was due to C. auris infection (14, 18). Currently, there are Drosophila melanogaster and Galleria mellonella models for C. auris infection.…”