Department of Neurology, Isala Hospital, Zwolle, the Netherlands.
Laboratory of Medical Microbiology and Infectious Diseases, Isala Hospital, Zwolle, the Netherlands.
Mult Scler Relat Disord. 2020 Jul;42:102137. doi: 10.1016/j.msard.2020.102137. Epub 2020 Apr 29.
We present a case of meningitis caused by Cryptococcus neoformans var. grubii in a 46-year old non-HIV-infected patient with multiple sclerosis, treated with dimethyl fumarate monotherapy. We identified no other risk factors for developing cryptococcal meningitis. The patient presented with a slowly progressive headache during preceding weeks and acute onset of confusion, nausea and vomiting. Clinical examination revealed intermittent disorientation without focal neurological symptoms. A lumbar puncture showed an opening pressure of > 50cmHO. Diagnosis of cryptococcal meningitis was made after culture of Cryptococcus neoformans var. grubii of cerebrospinal fluid.
This case emphasizes clinicians should bear in mind the possibility of cryptococcal meningitis in patients treated with dimethyl fumarate.
我们报告一例 46 岁非 HIV 感染多发性硬化症患者，使用富马酸二甲酯单药治疗后发生新型隐球菌变种引起的脑膜炎。我们未发现发生隐球菌性脑膜炎的其他危险因素。患者在之前数周逐渐出现头痛，随后急性出现意识混乱、恶心和呕吐。临床检查发现间歇性定向障碍，无局灶性神经症状。腰椎穿刺显示颅内压>50cmHO。通过脑脊液新型隐球菌变种培养诊断为隐球菌性脑膜炎。
该病例强调了临床医生应牢记使用富马酸二甲酯治疗的患者中隐球菌性脑膜炎的可能性。
