SYSTEMIC LUPUS ERYTHEMATOSUS AND CRYPTOCOCCAL INFECTION IN THE CENTRAL NERVOUS SYSTEM
- Simone Appenzeller, Brazil
Abstract
Background and Aims
Central nervous system (CNS) is an uncommon affected site by cryptococcal infection (CI) in patients with systemic lupus erythematous (SLE), and it can be very difficult to diagnose, especially in patients receiving immunosuppressive therapy, due to the insidious onset and non-specific symptoms. In addition, mortality can be high even with proper treatment.
Methods
The patients reported here were followed at the Rheumatology division of the Hospital of Clinics of the University of Campinas and we retrospectively reviewed their charts and magnetic resonance imaging (MRI) findings.
Results
We report two patients with SLE that presented at the emergency with acute neurologic symptoms. One presented headache, altered visual acuity, photophobia and mental confusion and the other progressive left-sided hemiparesis. In both no SLE disease activity was observed. MRI showed multiple corticosubcortical lesions with contrast enhancement, restricted diffusion, perilesional edema and small hemorrhagic foci. Serum Cryptococcus neoformans capsular antigen test, by the latex agglutination method, was positive in both cases. Patients were treated with amphotericin B with improvement of symptoms
Conclusions
Central nervous system infection by cryptococcus, in patients with systemic lupus erythematosus, should be suspected in cases of unspecific neurological symptoms such as headache and fever. MRI evaluation should be performed to better characterize the sites of lesion, and, depending of them (meningeal enhancement, ventricular dilatation and even nodular enhancement) this differential diagnosis must always be kept in mind especially in patients receiving steroid treatment.