Cryptococcal meningitis associated with steroid therapy

Abstract

Two patients on prolonged steroid therapy developed meningitis due toCryptococcus neoformans.The first responded satisfactorily to treatment with amphotericin B, both initially and again following relapse. The second died shortly after treatment was begun. Pathogenicity studies suggest that the strain isolated from the fatal case was the more virulent.Cryptococcal meningitis probably occurs more often in Britain than is generally appreciated, and this possibility should be remembered when investigating patients with obscure forms of meningitis; if not, then the correct diagnosis may not be made. Attention is drawn to the increasing number of recently reported cases of this disease which have been associated with long-term steroid therapy.

Cryptococcal eye disease

“…The similarity of cryptococcal meningitis to tuberculous meningitis and the difficulties encountered in its diagnosis, as illustrated in this case report, are weU documented (Wilson et al, 1970). Similar difficulties can also be encountered in the diagnosis of cryptococcal eye disease.…”

Criptococosis meníngea y lupus eritematoso sistémico: Reporte de un caso y revisión de la literatura

“…El examen microscópico es positivo entre 50 y 60% de los casos. Sin embargo, aunque el estudio del LCR muestre un recuento de leucocitos normal, no debe descartarse el diagnóstico de criptococcosis meníngea en pacientes con LES, por lo que las preparaciones con tinta china son necesarias para completar el estudio diagnóstico 18 . De los nueve pacientes con LES y criptococcosis meníngea reportados por Hung y cols 14 , 4 de ellos mostraron recuento de leucocitos normal en el análisis del LCR.…”

Cryptococcal meningitis as a complication of systemic lupus erythematosus treated with systemic corticosteroids

“…In regions where the disease is endemic, infections are commoner in men, with two-thirds of cases occurring between the third and fifth decades. The disease is prevalent in patients with Hodgkin's disease, lymphosarcoma, and diabetes mellitus; in some series, 50% of the cases occurred in association with such underlying diseases (Wilson et al, 1970). Where the disease is endemic, the primary route of infection is the lungs, although one-third of such pulmonary infections are without symptoms, and diagnosis is made as an incidental finding on a chest radiograph.…”