Vishal Singh, MD
Critical Care
AdventHealth Orlando, United States
Disclosure information not submitted.
Kishankumar Patel, MD
Critical Care
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Hector Vazquez, MD
Program Director
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Christian Almanzar Zorilla, MD
Internal Medicine
Brandon Regional Hospital, United States
Disclosure information not submitted.
Yelixa Santos Roman, MD
Critical Care
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Gustavo Lagrotta, DO
Pulmonary
Aventura Hospital and Medical Center
Aventura, Florida, United States
Disclosure information not submitted.
Title: A Rare Infection following COVID 19 Pneumonia Treatment
Case Report Body:
Introduction: Cryptococcus neoformans is an opportunistic fungus which causes severe meningoencephalitis in immunocompromised individuals. Multiple cases of secondary infections have been reported following infection with COVID 19 virus. We present a case of severe cryptococcal meningoencephalitis four months after diagnosis and treatment of COVID 19 Pneumonia.
Description: A 75 year old Caucasian male with medical history of COPD, Benign Prostatic Hypertension, and Hyperlipidemia was admitted for worsening dyspnea. He had been previously hospitalized four months ago, treated with Remdesivir and Decadron 6 mg daily for 10 days and was discharged on oxygen therapy. Upon admission he was noted to have fibrotic changes on CT imaging and was started on empiric azithromycin and ceftriaxone, and methylprednisolone 40 mg twice daily for an acute COPD exacerbation. He had a negative COVID 19 PCR this admission. However 3 days after his admission, a rapid response was called for altered mental status. He had a GCS of 7 on arrival. He was emergently intubated due to agonal breathing and risk of aspiration. Ventriculomegaly was evident on Brain MRI. A Lumbar Puncture revealed high protein, 100% mononuclear cells, and 1:1280 Cryptococcus antigen titers. CSF culture was positive for Cryptococcal neoformans. He received liposomal Amphotericin, Flucytosine, serial lumbar punctures and a lumbar drain. However his course was complicated by prolonged mechanical ventilation, Pseudomonas pneumonia and persistent encephalopathy warranting a tracheostomy, gastrostomy tube and long term care placement.
Discussion: Cryptococcal species are prevalent in soil rich in bird droppings. Patients with impaired cellular immunity are prone to infections like meningoencephalitis via inhalation of spores. Upon literature review we found 3 cases of COVID 19 and Cryptococcal coinfection - two of which were a kidney transplant patient with cirrhosis, and a patient who received tocilizumab. Although our patient had no such exposures, the use of steroids may suppress T-cell function. Additionally, COVID 19 infection has been postulated to cause direct T-cell immune dysfunction thus highlighting the importance of continued vigilance for secondary infections following COVID 19 infection and treatment.