Zhong Yuhua, Li Min, Liu Jia, Zhang Weixi, Peng Fuhua
Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, Guangdong 510630, China.
Department of Neurology, The First Affiliated Hospital Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China.
Clin Neurol Neurosurg. 2015 Apr;131:59-63. doi: 10.1016/j.clineuro.2015.01.023. Epub 2015 Feb 2.
Systemic lupus erythematosus (SLE) is a chronic immunologic disorder that can affect multiple organ systems and makes the patient susceptible to infection. Cryptococcal meningitis (CM) is a rare but often fatal complication of SLE.
In this study, 6 patients with CM were identified among 631 patients with SLE. The demographic, clinical, laboratory profiles, serological features and outcomes of these 6 SLE patients with CM were retrospectively analyzed.
The mean age of these patients was 24.1 years (range 12-42) at the time of SLE diagnosis, and 27.1 years (range 14-42) at the time of Cryptococcus neoformans infection, with mean disease duration of 37 months (range 3-72). Four patients had active SLE. All patients were receiving glucocorticoids therapy (mean prednisone dose of 20.5 (5.0-36.0) mg/day) at the onset of infection. Five patients had received other immunosuppressive drugs. The most common presentations of CM were headache and fever and 4 of the 6 patients were normal on physical examination. The cerebrospinal fluid (CSF) indices (protein and glucose) were normal in 4 cases, whereas they were mildly abnormal in the other 2 patients. White counts in the CSF ranged from 8 to 240 cells/mm. C. neoformans were isolated from CSF of 4 patients. The isolation of crytococci from extraneural sites, including blood and lungs, was found in 2 patients. Results of the head computed tomography scan were unremarkable in 5 of the patients. The infection was completely resolved in 5 patients, and it was resolved with serious sequelae in one patient.
In conclusion, the key to a rapid diagnosis of CM in patients with SLE is to maintain a high degree of awareness which will help avoid delays in treatment. This is mainly due to the fact that the clinical presentation and laboratory results from routine hematological, biochemical and CSF analyses of CM in patients with SLE are mostly non-specific.
系统性红斑狼疮（SLE）是一种慢性免疫紊乱疾病，可累及多个器官系统，使患者易发生感染。隐球菌性脑膜炎（CM）是SLE一种罕见但常致命的并发症。
本研究在631例SLE患者中识别出6例CM患者。对这6例SLE合并CM患者的人口统计学、临床、实验室检查结果、血清学特征及转归进行回顾性分析。
这些患者SLE诊断时的平均年龄为24.1岁（范围12 - 42岁），新型隐球菌感染时的平均年龄为27.1岁（范围14 - 42岁），平均病程为37个月（范围3 - 72个月）。4例患者SLE处于活动期。所有患者在感染发生时均接受糖皮质激素治疗（泼尼松平均剂量为20.5（5.0 - 36.0）mg/天）。5例患者曾接受其他免疫抑制药物治疗。CM最常见的表现为头痛和发热，6例患者中有4例体格检查正常。4例患者脑脊液（CSF）指标（蛋白和葡萄糖）正常，另外2例患者轻度异常。CSF中的白细胞计数为8至240个细胞/mm。4例患者的CSF中分离出新型隐球菌。2例患者在包括血液和肺在内的神经外部位分离出隐球菌。5例患者头部计算机断层扫描结果无明显异常。5例患者感染完全缓解，1例患者缓解但有严重后遗症。
总之，快速诊断SLE患者CM的关键是保持高度警惕，这有助于避免治疗延误。这主要是因为SLE患者CM的临床表现以及常规血液学、生化和CSF分析的实验室结果大多是非特异性的。
