title: Cryptococcus neoformans meningoencephalitis in a patient with polyarteritis nodosa.
abstract: Case of 59-year-old male with chronic obstructive pulmonary disease and a number of comorbidities, who has developed meningoencephalitis caused by Cryptococcus neoformans var. grubii with polyarteritis nodosa diagnosed during hospitalization, was presented. Before evidence of meningoencephalitis, the patient was being treated with ketoconazole and low doses of fluconazole (200 mg/day) for alleged candidiasis. The dosage was increased (800 mg/day) following laboratory diagnosis of C. neoformans based on positive latex agglutination test and biochemical identification of encapsulated yeast isolated from the blood and CSF. Later, the yeast identification was confirmed by sequencing analysis. Owing to inadequate clinical response, fluconazole therapy was switched to voriconazole (400 mg/day) and later to intravenous amphotericin B (1.0 mg/kg per day). Despite of a temporary stabilization and improvement, which correlated with decline of cryptococcal antigen titers (from 1:1024 to 1:8), after 6 weeks, the patient's underlying condition deteriorated due to severe pancolitis and serious nosocomial bacterial infections. The patient died of multiorgan failure several days later. Our case demonstrates a possible connection between the development of life-threatening cryptococcosis and an autoimmune vasculitis disease and emphasizes that the outcome of the management of cryptococcal meningoencephalitis is highly dependent on early diagnosis, adequate treatment, including dosage, and last but not least control of underlying disease and risk factors.
authors.affiliation: Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic, buchta@fnhk.cz.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Buchta
authors.forename: Petr
authors.initials: P
authors.lastname: Prášil
authors.forename: Marcela
authors.initials: M
authors.lastname: Vejsová
authors.forename: Roman
authors.initials: R
authors.lastname: Mottl
authors.forename: Radka
authors.initials: R
authors.lastname: Kutová
authors.forename: Marcela
authors.initials: M
authors.lastname: Drahošová
authors.forename: Stanislav
authors.initials: S
authors.lastname: Plíšek
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D003455:Cryptococcus neoformans / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D017809:Fatal Outcome; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole