Refractory Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient: Paradoxical Antifungal Therapy-Induced Clinical Deterioration Related to an Immune Response to Cryptococcal Organisms.
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.
['Nakajima|Hideto|H|', 'Takayama|Ayami|A|', 'Fujiki|Yohei|Y|', 'Ito|Takumi|T|', 'Kitaoka|Haruko|H|']
Cryptococcus neoformans Paradoxical antifungal therapy-induced clinical deterioration Cryptococcal antigen titer Corticosteroid Cryptococcal meningoencephalitis Immunocompetent host