Clinical Report: Amphotericin B-Resistant Cryptococcus laurentii Meningitis

Overview

This report details a case of Cryptococcus laurentii meningitis resistant to amphotericin B in a patient with pauci-immune crescentic glomerulonephritis and pulmonary tuberculosis. The case highlights the diagnostic and therapeutic challenges posed by rare fungal infections in immunocompromised patients.

Background

Pauci-immune glomerulonephritis due to ANCA vasculitis requires intensive immunosuppression, increasing the risk of opportunistic infections. Cryptococcosis, particularly caused by non-neoformans species like Cryptococcus laurentii, is rare but poses significant challenges in diagnosis and treatment, especially in regions with high tuberculosis prevalence. Understanding these infections is critical for effective management in vulnerable populations.

Data Highlights

No numerical data available.

Key Findings

• A 17-year-old male with pauci-immune crescentic glomerulonephritis developed cryptococcal meningitis.
• CSF analysis confirmed Cryptococcus laurentii with resistance to amphotericin B (MIC ≥ 16 µg/mL).
• The patient was treated with liposomal amphotericin B and high-dose fluconazole, but the CSF remained positive for cryptococcal infection.
• Amphotericin B was discontinued after culture results, and treatment was continued with fluconazole alone.
• Co-occurrence of pulmonary tuberculosis complicated the clinical picture, necessitating careful management.

Clinical Implications

This case underscores the importance of considering rare fungal pathogens in immunocompromised patients presenting with meningitis. Clinicians should be aware of the potential for drug resistance and the need for tailored antifungal therapy, especially in resource-limited settings.

Conclusion

The case illustrates the complexities of diagnosing and treating amphotericin B-resistant cryptococcal meningitis in the context of significant comorbidities. Ongoing vigilance and adaptation of treatment strategies are essential for optimal patient outcomes.

Related Resources & Content

1. KDIGO 2024 Clinical Practice Guideline for the Management of Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis
2. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM
3. Open Forum Infectious Diseases — Unmasking Lomentospora prolificans: A Case Study of Fungemia with Diagnostic Challenges
4. Open Forum Infectious Diseases — Challenges Associated with the MTB/RIF Assay: A Review of Four Clinical Cases
5. Intensive Care Medicine — Cryptococcal Infection in the Pleura of an Immunocompromised Individual
6. Open Forum Infectious Diseases — Broadening the Scope of Epidemiology: A Case Report of Pulmonary Illness Linked to Acrophialophora angustiphialis
7. KDIGO 2024 Clinical Practice Guideline for the Management of Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis
8. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM
9. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents