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Journal of Neuro-Oncology

, Volume 89, Issue 1, pp 51–53 | Cite as

Cryptococcal meningitis in patients with glioma: a report of two cases

  • Jonathan D. Choi
  • Ciaran J. Powers
  • James J. Vredenburgh
  • Allan H. Friedman
  • John H. Sampson
Clinical-patient studies

Abstract

Objective and importance We describe two patients with high-grade glioma undergoing treatment with corticosteroids and chemotherapy who presented with cryptococcal meningitis and sepsis. This report of two cases highlights the importance of examining the efficacy of prophylactic antibiotic and/or antifungal regimens in this patient population due to their increased risk of opportunistic infections. Clinical presentation A 73-year-old man with a history of glioblastoma multiforme (GBM), on dexamethasone and status post radiation therapy and two cycles of temozolamide, presented with decreased level of consciousness for 24 h and was found to have cerebrospinal fluid (CSF) and blood cultures positive for Cryptococcus neoformans. A 33-year-old man with a history of anaplastic astrocytoma, on dexamethasone and status post radiation therapy, four cycles of temozolomide and two cycles of Lomustine (CCNU), presented with headache, dizziness and photophobia and was found to have CSF and blood cultures positive for Cryptococcus neoformans. Intervention Both patients were treated with an initial regimen of amphotericin B and flucytosine for a minimum of two weeks and switched to fluconazole for 6 months to 1 year of treatment. Conclusion Patients with high-grade glioma treated with long-term corticosteroid therapy and chemotherapy are at increased risk of developing opportunistic infections. The two patients reported here developed cryptococcal meningitis and sepsis. Prophylactic regimens with either fluconazole or itraconazole currently exist that effectively decrease the incidence of both cryptococcal infections. Further investigations into the risk:benefit ratio of primary prophylactic therapy in this patient population may prove beneficial.

Keywords

Cryptococcus Glioma Corticosteroid Chemotherapy Opportunistic infections Immunosuppresion 

References

  1. 1.
    DeAngelis LM (2001) Brain tumors. N Engl J Med 344:114–123PubMedCrossRefGoogle Scholar
  2. 2.
    Kaal EC, Vecht CJ (2004) The management of brain edema in brain tumors. Curr Opin Oncol 16:593–600PubMedCrossRefGoogle Scholar
  3. 3.
    Mahindra AK, Grossman SA (2003) Pneumocystis carinii pneumonia in HIV negative patients with primary brain tumors. J Neurooncol 63:263–270PubMedCrossRefGoogle Scholar
  4. 4.
    Slivka A, Wen PY, Shea WM, Loeffler JS (1993) Pneumocystis carinii pneumonia during steroid taper in patients with primary brain tumors. Am J Med 94:216–219PubMedCrossRefGoogle Scholar
  5. 5.
    Stokes DC, Shenep JL, Horowitz ME, Hughes WT (1988) Presentation of Pneumocystis carinii pneumonia as unilateral hyperlucent lung. Chest 94:201–202PubMedCrossRefGoogle Scholar
  6. 6.
    Hughes MA, Parisi M, Grossman S, Kleinberg L (2005) Primary brain tumors treated with steroids and radiotherapy: low CD4 counts and risk of infection. Int J Radiat Oncol Biol Phys 62:1423–1426PubMedGoogle Scholar
  7. 7.
    Pruitt AA (2005) Treatment of medical complications in patients with brain tumors. Curr Treat Options Neurol 7:323–336PubMedCrossRefGoogle Scholar
  8. 8.
    Pappas PG, Perfect JR, Cloud GA, Larsen RA, Rankey GA, Lancaster DJ, Henderson H, Kauffman CA, Haas DW, Saccente M, Hamill RJ, Holloway MS, Warren RM, Dismukes WE (2001) Cryptococcus in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis 33:690–699PubMedCrossRefGoogle Scholar
  9. 9.
    Chang LW, Phipps WT, Kennedy GE, Rutherford GW (2005) Antifungal interventions for the primary prevention of cryptococcal disease in adults with HIV. Cochrane Database Syst Rev 3:1469–1493Google Scholar
  10. 10.
    Chetchotisakd P, Sungkanuparph S, Thinkhamrop B, Mootsikapun P, Boonyaprawit P (2004) A multicentre, randomized, double-blind, placebo-controlled trial of primary cryptococcal meningitis prophylaxis in HIV-infected patients with severe immune deficiency. HIV Med 5:140–143PubMedCrossRefGoogle Scholar
  11. 11.
    Powderly WG, Finkelstein DM, Feinberg J, Frame P, He W, van der Horst C, Koletar SL, Eyster ME, Carey J, Waskin H, Hooton TM, Hyslop N, Spector SA, Bozzette SA (1995) A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immuno deficiency virus infection. N Engl J Med 332:700–705PubMedCrossRefGoogle Scholar
  12. 12.
    12. Pfizer (1997) Diflucan (fluconazole) package insert. Pfizer-Roerig Inc, New York, NYGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Jonathan D. Choi
    • 1
  • Ciaran J. Powers
    • 2
  • James J. Vredenburgh
    • 3
  • Allan H. Friedman
    • 2
  • John H. Sampson
    • 2
  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Division of Neurosurgery, Department of SurgeryDuke University Medical CenterDurhamUSA
  3. 3.Division of Medical Oncology, Department of MedicineDuke University Medical CenterDurhamUSA

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