Cryptococcal meningitis as initial presentation of systemic lupus erythematosus

Introduction: Infection is one of the most frequent etiology of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cryptococcal meningitis is a recognized complication of SLE with high mortality rates in those treated with immunosuppressive agents. We describe a patient wit...

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Detalles Bibliográficos
Autores principales: Subils, Gisela C., Maldonado, Franco S.
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2012
Materias:
crytococcal meningitis
SLE
opportunistic mycosis in SLE
meningitis criptococcica
infecciones oportunistas en LES
compromiso SNC en LES
criptococosis
LES
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/21438
Aporte de:
Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
id I10-R327-article-21438
record_format ojs
institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-327
container_title_str Revista de la Facultad de Ciencias Médicas de Córdoba
language Español
format Artículo revista
topic crytococcal meningitis
SLE
opportunistic mycosis in SLE
meningitis criptococcica
infecciones oportunistas en LES
compromiso SNC en LES
criptococosis
LES
spellingShingle crytococcal meningitis
SLE
opportunistic mycosis in SLE
meningitis criptococcica
infecciones oportunistas en LES
compromiso SNC en LES
criptococosis
LES
Subils, Gisela C.
Maldonado, Franco S.
Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
topic_facet crytococcal meningitis
SLE
opportunistic mycosis in SLE
meningitis criptococcica
infecciones oportunistas en LES
compromiso SNC en LES
criptococosis
LES
author Subils, Gisela C.
Maldonado, Franco S.
author_facet Subils, Gisela C.
Maldonado, Franco S.
author_sort Subils, Gisela C.
title Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
title_short Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
title_full Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
title_fullStr Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
title_full_unstemmed Cryptococcal meningitis as initial presentation of systemic lupus erythematosus
title_sort cryptococcal meningitis as initial presentation of systemic lupus erythematosus
description Introduction: Infection is one of the most frequent etiology of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cryptococcal meningitis is a recognized complication of SLE with high mortality rates in those treated with immunosuppressive agents. We describe a patient with cryptoccoccal meningitis and SLE. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections. Clinical case: A 25 years old woman was admitted because of Pelvic Inflammatory Disease. She had ascitis and abdominal pain and neurological examination was normal.. Laboratory findings showed mild anemia, leukocytes: 6350/mm3 . Total lymphocytes: 508/mm3 (CD4 +: 75 cel/mm3). Erythrocyte sedimentation rate (ESR): 40mm/h, Coombs test (+). Abdominal CT scan showed ascites and pleural bilateral effusion. Two days after her admission, VDRL test was positive ( 1/64). Lumbar puncture was done and the r cerebrospinal fluid showed: normal glucose and protein level with normal cells. Fungi elements were found and Cryptococcus neoformans were identified. She received Anfotericin B treatment. HIV and TPHA test were negative. Antinuclear and anti-ds-DNA were positive in high levels and low levels of complement were found. Methylprednisolone pulses were s administered intravenously for three days. Cerebrospinal fluid was normal after 10 weeks of antifungical treatment.
publisher Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2012
url https://revistas.unc.edu.ar/index.php/med/article/view/21438
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AT maldonadofrancos cryptococcalmeningitisasinitialpresentationofsystemiclupuserythematosus
AT subilsgiselac meningitiscriptococcicacomoformadepresentaciondelupuseritematososistemico
AT maldonadofrancos meningitiscriptococcicacomoformadepresentaciondelupuseritematososistemico
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spelling I10-R327-article-214382024-08-27T18:23:15Z Cryptococcal meningitis as initial presentation of systemic lupus erythematosus Meningitis criptococcica como forma de presentacion de lupus eritematoso sistémico Subils, Gisela C. Maldonado, Franco S. crytococcal meningitis SLE opportunistic mycosis in SLE meningitis criptococcica infecciones oportunistas en LES compromiso SNC en LES criptococosis LES Introduction: Infection is one of the most frequent etiology of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cryptococcal meningitis is a recognized complication of SLE with high mortality rates in those treated with immunosuppressive agents. We describe a patient with cryptoccoccal meningitis and SLE. This case suggests that intrinsic immunological abnormality related to SLE predisposed to opportunistic infections. Clinical case: A 25 years old woman was admitted because of Pelvic Inflammatory Disease. She had ascitis and abdominal pain and neurological examination was normal.. Laboratory findings showed mild anemia, leukocytes: 6350/mm3 . Total lymphocytes: 508/mm3 (CD4 +: 75 cel/mm3). Erythrocyte sedimentation rate (ESR): 40mm/h, Coombs test (+). Abdominal CT scan showed ascites and pleural bilateral effusion. Two days after her admission, VDRL test was positive ( 1/64). Lumbar puncture was done and the r cerebrospinal fluid showed: normal glucose and protein level with normal cells. Fungi elements were found and Cryptococcus neoformans were identified. She received Anfotericin B treatment. HIV and TPHA test were negative. Antinuclear and anti-ds-DNA were positive in high levels and low levels of complement were found. Methylprednisolone pulses were s administered intravenously for three days. Cerebrospinal fluid was normal after 10 weeks of antifungical treatment. Introducción: En los pacientes con LES, las infecciones son una causa frecuente de morbilidad y mortalidad, que pueden ser atribuidas a múltiples disturbios en los componentes que constituyen el sistema inmune, en combinación con los efectos de la terapia inmunosupresora que representan el mayor factor de riesgo intrínseco que favorece a la infección. Caso clínico: Mujer de 25 años de edad que ingresa por abdomen agudo ginecológico de dos semanas de evolución, probable EIP. Abdomen distendido, doloroso con peritonismo, onda ascítica (+); examen neurológico sin anormalidades. Laboratorio: ligera anemia, leucocitos: 6350/mm3 . Linfocitos totales: 508/mm3 (CD4+: 75 cel/ mm3). VSG: 40mm/h, prueba de Coombs positiva. TC de abdomen presentaba ascitis y derrame pleural bilateral. Al 2° día se recibió resultado de VDRL positiva 1/64; se realiza punción lumbar, LCR con parámetro bioquímicos normales, hallazgo de elementos levaduriformes capsulados a la tinción de tinta china, identificados como Cryptococcus neoformans. Se inicia tratamiento con anfotericina B a 1mg/kg/día. Posteriormente se recibieron resultados de serologías VIH y TPHA no reactivos; hipocomplementemia; ANA y ac. anti-ADN positivos. Se inicio tratamiento esteroideo a dosis de 1 mg/kg. Buena evolución clínica y de parámetros de laboratorio, con esterilización de cultivos de LCR luego de 10 semanas de antifúngicos. Discusión: La meningitis criptococcica puede ser una forma de presentación de la enfermedad aún sin manifestaciones neurológicas en pacientes lúpicos. Es de vital importancia el diagnóstico precoz y la implementación de una terapia antifúngica efectiva. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2012-03-27 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/21438 10.31053/1853.0605.v69.n1.21438 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 69 No. 1 (2012); 47-50 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 69 Núm. 1 (2012); 47-50 Revista da Faculdade de Ciências Médicas de Córdoba; v. 69 n. 1 (2012); 47-50 1853-0605 0014-6722 10.31053/1853.0605.v69.n1 spa https://revistas.unc.edu.ar/index.php/med/article/view/21438/21089 Derechos de autor 2012 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0

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