• Honglei Ma, Yuqun Wang, Junhong Liu, Linping Du, Xiaodong Wang, and Yingliang Wang.
• Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, People's Republic of China.
• Medicine (Baltimore). 2023 Apr 14; 102 (15): e33541e33541.

RationalePatients with systemic lupus erythematosus (SLE) complicated with cryptococcal meningitis (CM) are easy to be misdiagnosed as neuropsychiatric lupus or tuberculous meningitis due to the lack of specificity of clinical symptoms, which may delay treatment. Through this case, we considered early improvement of India ink stain of cerebrospinal fluid (CSF) and metagenomic next generation sequences to determine whether there is microbial infection, and gave the idea of empirical anti-infection therapy, so as to make early diagnosis and slow down the progression of the disease.Patient ConcernsWe report the case of a 40-year-old female with SLE for 10 years. Five days ago she came down with a fever and a headache.Diagnosis, Interventions, And OutcomesIndia ink stain of CSF in patients with SLE shows Cryptococcus neoformans growth. Combined with imaging findings, the patient was diagnosed with CM. The patient improved after 3 weeks of antifungal therapy with amphotericin B 42 mg/d and flucytosine 6000 mg/d.LessonsThe possibility of CM should be considered when SLE patients have sudden headache and fever. India ink stain of CSF and metagenomic next generation sequences should be actively improved in the early stage of the disease to identify whether there is microbial infection, and early empirical anti-infection treatment should be given to reduce mortality.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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