[Cryptococcal meningitis as initial presentation of systemic lupus erythematosus].
BACKGROUND
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.


METHODS
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/mm(3). Total lymphocytes: 508/mm(3) (CD4 +: 75 cel/mm(3)). 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.
Servicio de clínica medica - Hospital Rawson Bajada Pucara 2025, ciudad de Córdoba, Córdoba, Argentina. giselasubils@hotmail.com
Gisela C
GC
Subils
Franco S
FS
Maldonado
D000328:Adult; D003455:Cryptococcus neoformans; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D016919:Meningitis, Cryptococcal / Q000209:etiology*