Posterior Reversible Encephalopathy Syndrome and Fatal Cryptococcal Meningitis After Immunosuppression in a Patient With Elderly Onset Inflammatory Bowel Disease.
Advanced age and associated comorbidities are-recognized predictors of life-threatening adverse outcomes, such as opportunistic infection following immunosuppressive therapy. We describe the case of an elderly patient with stricturing colonic Crohn's disease and significant clinical comorbidities, initially controlled with corticosteroid induction followed by infliximab, whose course was complicated by fatal disseminated cryptococcal infection and posterior reversible encephalopathy syndrome. Our patient's case highlights rare, but serious, complications of immunosuppression. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this potentially vulnerable group, maximizing benefit and minimizing harm.
Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, United Kingdom; Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom.
Dipesh H
DH
Vasant
Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, United Kingdom; Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom.
Jimmy K
JK
Limdi
Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, United Kingdom; Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom.
Simon P
SP
Borg-Bartolo
Department of Infectious Diseases, Pennine Acute Hospitals NHS Trust, United Kingdom; Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom.
Alec
A
Bonington
Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, United Kingdom.
Regi
R
George