• Case reports in neurology · Sep 2015

    Case Reports

    Refractory Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient: Paradoxical Antifungal Therapy-Induced Clinical Deterioration Related to an Immune Response to Cryptococcal Organisms.

    • Hideto Nakajima, Ayami Takayama, Yohei Fujiki, Takumi Ito, and Haruko Kitaoka.
    • Department of Internal Medicine, Seikeikai Hospital, Sakai, Japan ; Department of Internal Medicine I, Osaka Medical College, Takatsuki, Japan.
    • Case Rep Neurol. 2015 Sep 1; 7 (3): 204-8.

    AbstractWe 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.

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