Breakthrough cryptococcosis in a patient with systemic lupus erythematosus (SLE) receiving micafungin

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
Kei SuzukiNaoyuki Katayama

Abstract

A 67-year-old woman with systemic lupus erythematosus (SLE) was admitted to our hospital because of lupus nephritis. Methylprednisolone minipulse therapy dramatically reduced her proteinuria; however; she then complained of general fatigue with low-grade fever. Radiological and culture studies revealed no infectious focus, but she was treated with meropenem and micafungin, considering her immunosuppressive state. Cytomegalovirus antigenemia was later determined and ganciclovir was added. She became afebrile, but complained of nausea and headache, and disorientation, without meningeal signs. Because a brain computed tomography (CT) scan showed no abnormality, we initially suspected some kind of drug interaction. Despite the discontinuation of all drugs, however, she still suffered from disturbance of consciousness. A lumbar puncture revealed yeast cells stained by India ink. A diagnosis of cryptococcal meningitis was confirmed. Though fluconazole and meropenem were administered, the patient died. Autopsy findings revealed disseminated cryptococcosis concomitant with pulmonary aspergillosis. Micafungin is a recently approved echinocandin-class antifungal agent that is now widely used in Japan because of its minimal toxicity and b...Continue Reading

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Citations

May 20, 2014·The Journal of Emergency Medicine·Spinello AntinoriLaura Milazzo
May 2, 2013·Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi·Wen-Sen LeeFu-Der Wang
Jan 10, 2012·The Journal of Infection·Katy-Anna Phai PangRaoul Herbrecht
Dec 29, 2009·International Journal of Antimicrobial Agents·Hsin-Yun Sun, Nina Singh
Sep 13, 2011·Expert Review of Anti-infective Therapy·Melike Emiroglu

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