Cryptococcal meningoencephalitis in multiple sclerosis treated with fingolimod.
Moneeb NasirIan GaleaSanjeev RajakulendranKaren ChungPublished in: Practical neurology (2023)
A 21-year-old woman with multiple sclerosis (taking regular fingolimod) developed sudden-onset severe headache with nausea and malaise. Neurological examination was normal and she was afebrile. Blood results showed lymphocytes 0.53 x 10 9 /L and C reactive protein 19 mg/L. CT scan of head and venogram were normal. CSF showed an opening pressure of 33 cm H 2 O and an incidental light growth of Cryptococcus neoformans , confirmed with positive India Ink stain and a positive cryptococcal antigen (1:100). She was treated for cryptococcal meningoencephalitis with amphotericin and flucytosine. Her presenting symptoms had closely mimicked subarachnoid haemorrhage. This atypical presentation of cryptococcal CNS infection highlights the need for vigilance in immunosuppressed patients.
Keyphrases
- multiple sclerosis
- newly diagnosed
- end stage renal disease
- white matter
- computed tomography
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- case report
- prognostic factors
- early onset
- magnetic resonance imaging
- peripheral blood
- image quality
- contrast enhanced
- dual energy
- drug induced
- chemotherapy induced