Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy – a case report

Abstract

BackgroundCryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature.Case presentationWe reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis.ConclusionThrough this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving.

Advances and ongoing research in the treatment of autoimmune neuromuscular junction disorders

“…Case reports of opportunistic viral, bacterial, or fungal infections have been reported with the use of conventional immunosuppressants. 113,114 These new drugs-complement inhibitors, FcRn blockers, and monoclonal antibodies against CD19 or CD20-might substantially improve quality of life and diminish the adverse effects of long-term corticosteroids or the bone-marrow toxicity of current immunosuppressive drugs, but in several countries high costs are prohibitive. A 2020 Canadian pharmacoeconomic report on eculizumab concluded that, despite several limitations in the analysis, eculizumab could not be considered costeffective without considerable price reduction.…”