Meningitis Caused by Rhodotorula mucilaginosa in HIV-Infected Patient: A Case Report and Review of the Literature.
Rhodotorula species are increasingly being identified as a cause of fungal infection in the central nervous system, especially in patients with compromised immunity. The diagnosis could easily be missed due to low index of suspicion, as cryptococcus meningitis and cerebral toxoplasmosis are more common amongst immunocompromised hosts. To date, there are six cases of Rhodotorula-related meningitis reported, and three are associated with human immunodeficiency virus infection. In this report, a case of a Malaysian male with underlying human immunodeficiency virus infection who developed Rhodotorula mucilaginosa meningitis is presented. High-grade fever and severe headaches were the complaints presented in three previous case reports. India ink and nigrosin stainings were performed in the two previous reports and both revealed positive results. R. mucilaginosa were isolated from the culture of the patient's cerebrospinal fluid in all three previous reports. Predominant lymphocyte infiltration in the cerebrospinal fluid examination was documented in two reports. CD4 counts were above 100/µl in two previously published reports, while another report documented CD4 count as 56/µl. Amphotericin B and itraconazole are identified to be the first line of antifungal used and as the maintenance therapy, respectively. The possibility of relapse cannot be excluded as it was reported in the first report. It was also revealed that the current case has almost similar clinical presentation and therapeutic outcome as compared to the published reports, but some differences in diagnostic details were to be highlighted.
Drug Discovery and Health Community Research, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia, fadzi456@salam.uitm.edu.my.
Fadzilah
F
Mohd Nor
Lian Huat
LH
Tan
Shi Ling
SL
Na
Kee Peng
KP
Ng
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002555:Cerebrospinal Fluid / Q000382:microbiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D008828:Microbiological Techniques; D012248:Rhodotorula / Q000302:isolation & purification*; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B