PMID- 17299987
OWN - NLM
STAT- MEDLINE
DCOM- 20070227
LR  - 20201209
IS  - 0385-2385 (Print)
IS  - 0385-2385 (Linking)
VI  - 49
IP  - 1
DP  - 2007
TI  - [A case of cryptococcal meningitis with nephrotic syndrome and renal 
      insufficiency under immunosuppressive therapy].
PG  - 54-9
AB  - A 76 year-old woman was admitted to our hospital because of pyrexia and fatigue. 
      One year earlier, she was diagnosed as nephrotic syndrome(NS) caused by focal 
      segmental glomerulosclerosis and immunosuppressive therapy was started with 
      marked amelioration of proteinuria. Thereafter, her renal function worsened, but 
      only supportive treatment was continued. After admission, a cerebrospinal fluid 
      (CSF) examination revealed Cryptococcus neoformans (C. neoformans) by india ink 
      staining and a subsequent CSF culture confirmed C. neoformans infection. 
      Accordingly, we made the diagnosis of cryptococcal meningitis and immediately 
      started multiple anti fungal drugs with dosage modification according to her 
      impaired renal function. Immunosuppressive therapy for NS was temporarily 
      terminated. The inflammatory signs and symptoms soon were markedly improved, but 
      the anti cryptococcal antibody titer in the serum and CSF remained high. 
      Immunosuppressive therapy was started again at a low dosage because urinary 
      protein had increased again. One hundred and eight days from admission, she was 
      discharged with a regimen of multiple anti fungal drugs. Proteinuria and renal 
      insufficiency was almost stable during hospitalization. Most fungal infection 
      develops in patients in an immunosuppressive state induced by immunosuppressive 
      drugs, HIV infection and so on. Patients with NS are frequently in an 
      immunosuppressive state because of urinary loss of immunoglobulins and the use of 
      immunosuppressive drugs. Therefore, it should be remembered that patients with NS 
      are at a high risk of suffering from fungal infection.
FAU - Tsuchida, Hiroki
AU  - Tsuchida H
AD  - Division of Nephrology and Hypertension, Department of Internal Medicine, St. 
      Marianna University School of Medicine, Japan.
FAU - Ichikawa, Daisuke
AU  - Ichikawa D
FAU - Shima, Yoshinori
AU  - Shima Y
FAU - Yasuda, Takashi
AU  - Yasuda T
FAU - Sato, Takeo
AU  - Sato T
FAU - Kimura, Kenjiro
AU  - Kimura K
LA  - jpn
PT  - Case Reports
PT  - Journal Article
PL  - Japan
TA  - Nihon Jinzo Gakkai Shi
JT  - Nihon Jinzo Gakkai shi
JID - 7505731
RN  - 0 (Antifungal Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - 7XU7A7DROE (Amphotericin B)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - 8VZV102JFY (Fluconazole)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Aged
MH  - Amphotericin B/administration & dosage
MH  - Antifungal Agents/administration & dosage
MH  - Cryptococcus neoformans/isolation & purification
MH  - Cyclosporine/administration & dosage
MH  - Drug Administration Schedule
MH  - Female
MH  - Fluconazole/administration & dosage
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Meningitis, Cryptococcal/drug therapy/*etiology
MH  - Nephrotic Syndrome/complications/*drug therapy
MH  - Prednisolone/administration & dosage
MH  - Renal Insufficiency/complications/*drug therapy
EDAT- 2007/02/16 09:00
MHDA- 2007/02/28 09:00
CRDT- 2007/02/16 09:00
PHST- 2007/02/16 09:00 [pubmed]
PHST- 2007/02/28 09:00 [medline]
PHST- 2007/02/16 09:00 [entrez]
PST - ppublish
SO  - Nihon Jinzo Gakkai Shi. 2007;49(1):54-9.