Successful Treatment of Serial Opportunistic Infections Including Disseminated Nocardiosis and Cryptococcal Meningitis in a Patient with ANCA-associated Vasculitis

Iwazu, Kana; Iwazu, Yoshitaka; Takeda, Shin‐ichi; Akimoto, Tetsu; Yumura, Wako; Takahashi, Hideaki; Ito, Chiharu; Kanai, Kuniyuki; Taniguchi, Nobuyuki; Hirai, Yoshikazu; Kusano, Eiji

doi:10.2169/internalmedicine.51.7886

Cited by 9 publications

(1 citation statement)

References 27 publications

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“…Approximately 0.2% of the patients with rheumatoid arthritis (RA) complicated with cryptococcosis [5]. Cryptococcosis in other CTD such as systemic vasculitis was only reported in scattered cases [6,7]. Asia is the endemic region for cryptococcosis, [8] and the incidence and features of infection differed geographically.…”

Section: Introductionmentioning

confidence: 99%

Infective patterns of cryptococcosis in patients with connective tissue disease:a retrospective study

Lao

Gong

Shen

et al. 2019

Preprint

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Background: Cryptococcal infection is a life-threatening complication in patients with connective tissue disease (CTD). This retrospective study was performed to explore the clinical features and associated factors of cryptococcosis in patients with CTD from southern China. Methods: Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. Results: A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCA-associated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%) and disseminated cryptococcosis (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meninges (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.08-1.87, P = 0.01] was associated with cryptococcosis in patients with CTD. Conclusions: Cryptococcosis developed in various organs. Typical radiological manifestation accompanied with positive serum CrAg were helpful clues for diagnosis. Lumbar puncture was a critical diagnostic method to distinguish CM. The accumulated dose of GC was associated with cryptococcosis in patients with CTD.

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Section: Introductionmentioning

confidence: 99%

Infective patterns of cryptococcosis in patients with connective tissue disease:a retrospective study

Lao

Gong

Shen

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

et al. 2020

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Background: Cryptococcal infection is a life-threatening complication in patients with connective tissue disease (CTD). This retrospective study was performed to explore the clinical features and associated factors of cryptococcosis in patients with CTD from southern China. Methods: Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. Results: A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCAassociated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%) and disseminated cryptococcosis (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meninges (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.08-1.87, P = 0.01 was associated with cryptococcosis in patients with CTD. Conclusions: Cryptococcosis developed in various organs. Typical radiological manifestation accompanied with positive serum CrAg were helpful clues for diagnosis. Lumbar puncture was a critical diagnostic method to distinguish CM. The accumulated dose of GC was associated with cryptococcosis in patients with CTD. Background Infection is one of the major threats to patients with connective tissue disease (CTD) because of the immune disturbance and immunosuppressive therapy [1 ,2 ]. As one of the opportunistic infections, invasive fungal disease (IFD) is a matter of concern in immunocompromised hosts. Our previous study found that approximately 1.1% of the lupus patients develops IFD [3]. Aspergillus spp., Candida spp. and Cryptococcus spp. are the common causative agents. However, due to the limitation of sample

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Invasive fungal infection in ANCA-associated vasculitis: Between the Devil and Deep blue sea. Case series and review of the literature

Baliga,

Yadav,

Sagdeo

et al. 2023

Clin Rheumatol

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Successful Treatment of Serial Opportunistic Infections Including Disseminated Nocardiosis and Cryptococcal Meningitis in a Patient with ANCA-associated Vasculitis

Cited by 9 publications

References 27 publications

Infective patterns of cryptococcosis in patients with connective tissue disease:a retrospective study

Infective patterns of cryptococcosis in patients with connective tissue disease:a retrospective study

Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

Invasive fungal infection in ANCA-associated vasculitis: Between the Devil and Deep blue sea. Case series and review of the literature

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