Department of Neurology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Apr 28;46(4):438-443. doi: 10.11817/j.issn.1672-7347.2021.200471.
Cryptococcal meningitis has become the largest cause for the death of infectious diseases in the central nervous system infectious disease worldwide. Most patients with cryptococcal meningitis have AIDS, autoimmune diseases, hematologic malignancies, and some other relevant diseases. It is mainly caused by infection with or . Although the relationship between cryptococcal meningitis and autoimmune diseases, such as systemic lupus erythematosus, has been recognized, little has been studied about it. Furthermore, with the use of glucocorticoids and immunosuppressants, the incidence of cryptococcal meningitis is increasing year by year. Cryptococcal meningitis accounts for 15% of HIV-related deaths globally, compared with little research on HIV-negative cryptococcal diseases. A 54-year-old female patient with gingival bleeding was admitted to the Department of Neurology at the Second Xiangya Hospital of Central South University. The patient subsequently developed a series of central nervous system symptoms such as headache, ischemic stroke, and epilepsy. The number of thrombocytes was at 4×10/L, antinuclear antibody was (+), antihuman globulin was (++), globulin IgG anticardiolipin antibody IgG, IgA, and IgM was positive, lupus anticoagulant was strong positive, antibody against β2 glycoprotein 1 IgM >841 AU/mL with elevated cerebrospinal fluid (CSF) pressure. The CSF India ink staining was positive, CSF was cultured cryptococcus neoformans. Antiphospholipid syndrome (APS) and cryptococcal neoformans meningitis were diagnosed. After active antifungal therapy and control of APS, the patient still had a serial of complications including high CSF pressure, persistent positive India ink staining, refractory electrolyte disturbance, hemolytic anemia recurs, heart failure, and finally death. No cases of the combination of the two diseases have been reported, and this case of cryptococcal meningitis with APS may provide a new direction to the diagnosis and treatment for this kind of disease.
隐球菌性脑膜炎已成为全球中枢神经系统传染病中导致死亡的最大病因。大多数隐球菌性脑膜炎患者患有艾滋病、自身免疫性疾病、血液恶性肿瘤和其他一些相关疾病。它主要由感染 或 引起。尽管隐球菌性脑膜炎与系统性红斑狼疮等自身免疫性疾病之间的关系已得到认可，但对此研究甚少。此外，随着糖皮质激素和免疫抑制剂的使用，隐球菌性脑膜炎的发病率逐年增加。隐球菌性脑膜炎占全球与 HIV 相关死亡人数的 15%，而对 HIV 阴性隐球菌病的研究甚少。一名 54 岁女性牙龈出血患者被收入中南大学湘雅二医院神经内科。该患者随后出现一系列中枢神经系统症状，如头痛、缺血性中风和癫痫。血小板计数为 4×10/L，抗核抗体阳性，抗人球蛋白阳性，球蛋白 IgG 抗心磷脂抗体 IgG、IgA 和 IgM 阳性，狼疮抗凝物强阳性，β2 糖蛋白 1 抗体 IgM >841 AU/mL，脑脊液（CSF）压力升高。CSF 墨汁染色阳性，CSF 培养出新生隐球菌。诊断为抗磷脂综合征（APS）和新型隐球菌性脑膜炎。在积极进行抗真菌治疗和 APS 控制后，患者仍出现一系列并发症，包括高颅压、持续墨汁染色阳性、电解质紊乱难以控制、溶血性贫血反复发作、心力衰竭，最终死亡。未报道过两种疾病同时发生的病例，本例 APS 合并新型隐球菌性脑膜炎可能为该类疾病的诊断和治疗提供新方向。
