title: Disseminated cryptococcosis in a non-Hodgkin's lymphoma patient with late-onset neutropenia following rituximab-CHOP chemotherapy: a case report and literature review.
abstract: Rituximab-related late-onset neutropenia (R-LON) is an adverse event associated with rituximab. A 65-year-old woman presented with diffuse large B-cell lymphoma of the kidney without bone marrow involvement. She was treated with 4 cycles of CHOP chemotherapy consisting of doxorubicin, cyclophosphamide, vincristine, and prednisolone at 4-week intervals. Rituximab was also administrated of the second, third, fourth CHOP cycles. She developed a high fever of 38°C, nausea, and severe neutropenia following the four cycles of R-CHOP chemotherapy. Her leukocyte count was 160/μl without neutrophils. Initially, a blood and pleural fluid and cerebrospinal fluid cultures were positive for Cryptococcus neoformans. Once she became asymptomatic following treatment with fluconazole and neutropenia was recovered with lenograstim, she had neck stiffness and admitted soon. Cerebro-spinal fluid (CSF) culture was positive for Cryptococcus neoformans. Treatment with amphotericin B(AMPH-B) and flucytosine(5-FC) was initiated as diagnosis of cryptococcus meningitis. Lenograstim was administrated for 9 months, and amount of dose was 9,750 μg. Cryptococcosis with malignant lymphoma is rare disease, and previously 17 cases were reported. Of note, mortality of disseminated cryptococcosis with malignant lymphoma is 54%. The more and more rituximab is widely used; the cases of severe infection in R-LON may increase.
authors.affiliation: Department of Infectious Disease, Tokyo Women's Medical University, Tokyo, Japan. yuji-hirai@clabo.twmu.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ainoda
authors.forename: Takayo
authors.initials: T
authors.lastname: Shoji
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shiseki
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Masanao
authors.initials: M
authors.lastname: Teramura
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Totsuka
authors.forename: Toshiko
authors.initials: T
authors.lastname: Motoji
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D005437:Flucytosine / Q000008:administration & dosage; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000935:Antifungal Agents; D007155:Immunologic Factors; D000069283:Rituximab; D014750:Vincristine; D000666:Amphotericin B; D004317:Doxorubicin; D003520:Cyclophosphamide; D015725:Fluconazole; D011239:Prednisolone; D005437:Flucytosine