Abstract
The patient was a 72-year-old female who had myelodysplastic syndrome and had been receiving maintenance hemodialysis for 2 years due to purpura nephritis. Two months previously, she had developed a fever for which antibiotics were not effective. One week previously, disturbance of consciousness appeared. She was admitted to our hospital and underwent a lumbar puncture. The opening pressure was elevated by 40 cmH2O and examination of the CSF with India ink demonstrated encapsulated yeast forms. CSF and serum cryptococcal antigen tests were positive and, by culturing the organisms from CSF and blood Cryptococcus neoformans was isolated. We diagnosed cryptococcal meningoencephalitis. We used liposomal amphotericin B and flucytosine adjusted for renal function and repeated lumbar drainage. CSF and blood cultures became negative, but the disturbance of consciousness did not improve. Hemodialysis patients are immunocompromised due to defects in their cell-mediated immunity and neutrophil function, and are likely to have fungal infections. Cryptococcal infections have no characteristic symptoms, but are diagnosed by antigen tests. Delayed treatment is associated with increased mortality, so we should consider this disease when investigating fever of unknown origin in hemodialysis patients.
