Journal
CASE REPORTS IN NEUROLOGY
Volume 7, Issue 3, Pages 204-208Publisher
KARGER
DOI: 10.1159/000440948
Keywords
Cryptococcal meningoencephalitis; Corticosteroid; Cryptococcus neoformans; Immunocompetent host; Cryptococcal antigen titer; Paradoxical antifungal therapy-induced clinical deterioration
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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. (C) 2015 The Author(s) Published by S. Karger AG, Basel
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