Liang Dongrui, Li Xiaodong
2nd Department of Ophthalmology, Baoding No.1 Central Hospital of Hebei Medical University, Baoding, Hebei, People's Republic of China.
Department of Nephrology, Baoding No.1 Central Hospital of Hebei Medical University, Baoding, Hebei, People's Republic of China.
Risk Manag Healthc Policy. 2024 Jan 31;17:279-285. doi: 10.2147/RMHP.S451991. eCollection 2024.
Patients with primary nephrotic syndrome (PNS) are at an increased risk of developing various infections due to the long-term use of immunosuppressive agents. Cryptococcal meningitis (CM) is an uncommon but severe complication that can occur in patients with PNS, particularly those receiving immunosuppressive medications.
This case report describes a middle-aged female patient with PNS and type 2 diabetes mellitus (T2DM) who developed CM. She received a combination regimen of cyclophosphamide and prednisone, achieving partial remission of PNS. However, she later returned to the hospital with high fever and headache. At admission, her nasopharyngeal swab test was positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and she received therapy of dexamethasone and favipiravir, but her fever and headache were not improved. Following a lumbar puncture was performed for her and CM was diagnosed based on a positive Cryptococcus culture in the cerebrospinal fluid. The patient's cyclophosphamides were temporarily discontinued, and antifungal therapy with amphotericin B liposome and fluconazole was initiated. Despite a noticeable increase in her blood glucose levels due to infection during her hospitalization, she showed improvement with intensified glycemic control treatment. The anti-infection showed significant effectiveness, and the patient's proteinuria remained stable during follow-up.
The patient with PNS and T2DM was concurrently diagnosed with both CM and coronavirus disease 2019 (COVID-19), marking the first reported case of such co-infections in these patients. Prompt diagnosis and appropriate antifungal therapy are crucial for improved outcomes of PNS patients with CM and COVID-19.
原发性肾病综合征（PNS）患者由于长期使用免疫抑制剂，发生各种感染的风险增加。隐球菌性脑膜炎（CM）是一种罕见但严重的并发症，可发生在PNS患者中，尤其是那些接受免疫抑制药物治疗的患者。
本病例报告描述了一名患有PNS和2型糖尿病（T2DM）的中年女性患者发生了CM。她接受了环磷酰胺和泼尼松的联合治疗方案，PNS达到部分缓解。然而，她后来因高热和头痛再次入院。入院时，她的鼻咽拭子检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）呈阳性，她接受了地塞米松和法匹拉韦治疗，但发热和头痛并未改善。对她进行腰椎穿刺后，根据脑脊液中隐球菌培养阳性诊断为CM。患者的环磷酰胺暂时停用，并开始使用两性霉素B脂质体和氟康唑进行抗真菌治疗。尽管住院期间感染导致她的血糖水平显著升高，但通过强化血糖控制治疗她的病情有所改善。抗感染治疗显示出显著效果，患者的蛋白尿在随访期间保持稳定。
该PNS和T2DM患者同时被诊断为CM和2019冠状病毒病（COVID-19），这是这些患者中此类合并感染的首例报告病例。及时诊断和适当的抗真菌治疗对于改善患有CM和COVID-19的PNS患者的预后至关重要。
