title: Refractory Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient: Paradoxical Antifungal Therapy-Induced Clinical Deterioration Related to an Immune Response to Cryptococcal Organisms.
abstract: We present a case of refractory Cryptococcus neoformans meningoencephalitis in an immunocompetent woman. Her clinical symptoms did not improve with 6 months of antifungal therapy, and MRI abnormalities, indicating severe meningeal and cerebral inflammation, persisted despite a decreasing cryptococcal antigen titer. The patient continued to deteriorate despite antifungal therapy, and her condition clearly improved following treatment with adjunctive corticosteroid. We postulate that the paradoxical antifungal therapy-related clinical deterioration was due to an immune response to cryptococcal organisms, which responded to corticosteroids. These observations provide rationale for a further evaluation of corticosteroids in the management of select cases of C. neoformans central nervous system infection.
authors.affiliation: Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan ; Department of Internal Medicine I, Osaka Medical College, Takatsuki, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan ; Department of Internal Medicine I, Osaka Medical College, Takatsuki, Japan.
authors.forename: Ayami
authors.initials: A
authors.lastname: Takayama
authors.affiliation: Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan ; Department of Internal Medicine I, Osaka Medical College, Takatsuki, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Fujiki
authors.affiliation: Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan.
authors.forename: Haruko
authors.initials: H
authors.lastname: Kitaoka
keywords: Corticosteroid; Cryptococcal antigen titer; Cryptococcal meningoencephalitis; Cryptococcus neoformans; Immunocompetent host; Paradoxical antifungal therapy-induced clinical deterioration