H H Workel1, M J H M Wolfhagen2, J W Bouwhuis3, M E Kloosterziel4. 1. Department of Neurology, Isala Hospital, Zwolle, the Netherlands. Electronic address: h.h.workel@isala.nl. 2. Laboratory of Medical Microbiology and Infectious Diseases, Isala Hospital, Zwolle, the Netherlands. 3. Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands. 4. Department of Neurology, Isala Hospital, Zwolle, the Netherlands.
Abstract
INTRODUCTION: We present a case of meningitis caused by Cryptococcus neoformans var. grubii in a 46-year old non-HIV-infected patient with multiple sclerosis, treated with dimethyl fumarate monotherapy. We identified no other risk factors for developing cryptococcal meningitis. The patient presented with a slowly progressive headache during preceding weeks and acute onset of confusion, nausea and vomiting. Clinical examination revealed intermittent disorientation without focal neurological symptoms. A lumbar puncture showed an opening pressure of > 50cmH2O. Diagnosis of cryptococcal meningitis was made after culture of Cryptococcus neoformans var. grubii of cerebrospinal fluid. CONCLUSION: This case emphasizes clinicians should bear in mind the possibility of cryptococcal meningitis in patients treated with dimethyl fumarate.
INTRODUCTION: We present a case of meningitis caused by Cryptococcus neoformans var. grubii in a 46-year old non-HIV-infectedpatient with multiple sclerosis, treated with dimethyl fumarate monotherapy. We identified no other risk factors for developing cryptococcal meningitis. The patient presented with a slowly progressive headache during preceding weeks and acute onset of confusion, nausea and vomiting. Clinical examination revealed intermittent disorientation without focal neurological symptoms. A lumbar puncture showed an opening pressure of > 50cmH2O. Diagnosis of cryptococcal meningitis was made after culture of Cryptococcus neoformans var. grubii of cerebrospinal fluid. CONCLUSION: This case emphasizes clinicians should bear in mind the possibility of cryptococcal meningitis in patients treated with dimethyl fumarate.
Authors: Maurizio Del Poeta; Brian J Ward; Benjamin Greenberg; Bernhard Hemmer; Bruce A C Cree; Sreelatha Komatireddy; Jitendriya Mishra; Roseanne Sullivan; Ajay Kilaru; Alan Moore; Thomas Hach; Joseph R Berger Journal: Neurol Neuroimmunol Neuroinflamm Date: 2022-03-22