Corticosteroids for the management of severe intracranial hypertension in meningoencephalitis caused by Cryptococcus gattii : A case report and review

Maciel, R.-A.; Ferreira, Leonardo S.; Wirth, Fernanda; Rosa, Priscila Bárbara Zanini; Aves, M.; Turra, Eduardo Eggers; Goldani, Luciano Zubaran

doi:10.1016/j.mycmed.2016.09.003

Cited by 13 publications

(2 citation statements)

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“…Guo and colleagues reported that in patients suffering from CM-IRIS without HIV infection, after using corticosteroids, headache was relieved immediately and the pressure elicited by CSF decreased within a short time [ 34 ]. Corticosteroids have been shown to be efficacious in HIV-infected individuals with CM-IRIS in some studies [ 35 , 36 ]. However, cases of corticosteroid dependence have been reported, whereby inflammation relapses usually occurred if the corticosteroid dose was tapered or interrupted [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of lenalidomide in HIV-associated cryptococcal meningitis patients with persistent intracranial inflammation: an open-label, single-arm, prospective interventional study

Wan

Tao

Hui

et al. 2023

J Neuroinflammation

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Background Patients with human immunodeficiency virus-associated cryptococcal meningitis (HIV-CM) have persistent intracranial inflammation despite negative cerebrospinal fluid (CSF) fungal cultures after optimal treatment for CM, which could be devastating for the central nervous system. However, a definitive treatment strategy for persistent intracranial inflammation despite optimal antifungal therapies is undefined. Methods We identified 14 HIV-CM patients with persistent intracranial inflammation and conducted a 24-week, prospective, interventional study. All participants received lenalidomide (25 mg, p.o.) on days 1 to 21 of a 28-day cycle. Follow-up lasted for 24 weeks with visits at baseline and weeks 4, 8, 12, and 24. The primary endpoint was the change in clinical manifestations, routine CSF parameters, and MRI findings after lenalidomide treatment. An exploratory analysis was made on changes in cytokine levels in CSF. Safety and efficacy analyses were undertaken in patients who received at least one dose of lenalidomide. Results Of 14 participants, 11 patients completed the 24 weeks of follow-up. Rapid clinical remission following lenalidomide therapy was observed. Clinical manifestations (fever, headache, altered mentation) were reversed fully by week-4 and remained stable during follow-up. A significant reduction in white blood cell (WBC) count in CSF was noted occurred at week-4 (P = 0.009). The median protein concentration in CSF decreased from 1.4 (0.7–3.2) g/L at baseline to 0.9 (0.6–1.4) at week-4 (P = 0.004). The median albumin concentration in CSF decreased from 79.2 (48.4–149.8) mg/L at baseline to 55.3 (38.3–89.0) mg/L at week-4 (P = 0.011). The WBC count, protein level, and albumin level in CSF remained stable and approached a normal range through week-24. There was no significant change in immunoglobulin-G, intracranial pressure (ICP), or chloride-ion concentration at each visit. Brain MRI demonstrated multiple lesions to be absorbed post-therapy. Levels of tumor necrosis factor-α granulocyte colony stimulating factor, interleukin (IL)-6, and IL-17A decreased significantly during 24-week follow-up. Two (14.3%) patients had mild skin rash, which resolved spontaneously. Lenalidomide-related serious adverse events were not observed. Conclusion Lenalidomide could improve persistent intracranial inflammation in HIV-CM patients significantly and was well tolerated without serious adverse events observed. And the additional randomized controlled study is required to further validate the finding.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of lenalidomide in HIV-associated cryptococcal meningitis patients with persistent intracranial inflammation: an open-label, single-arm, prospective interventional study

Wan

Tao

Hui

et al. 2023

J Neuroinflammation

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“…Concerns related to an overly exuberant immune response have prompted the use of anti-inflammatory agents. There are case reports of corticosteroids reducing raised ICP and/or improving neurological sequelae in non-HIV cryptococcal meningoencephalitis [98][99][100] .…”

Section: Patients Die Because Of An Inability To Predict and Manage Immunological Dysregulationmentioning

confidence: 99%