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Case Reports
. 2024 Apr 23;16(4):e58852.
doi: 10.7759/cureus.58852. eCollection 2024 Apr.

Disseminated Cryptococcosis Post Eculizumab Therapy: A Case Report and Literature Review

Ibrahim Youssef  1 , Muhammad S Abbas  1 , Amir Manafi  1 , Hossein Akhondi  1 , Dima Youssef  2
Affiliations
Case Reports

Disseminated Cryptococcosis Post Eculizumab Therapy: A Case Report and Literature Review

Ibrahim Youssef et al. Cureus. .

Abstract

Eculizumab is a biologic medication used for the treatment of complement-related disorders including anti-acetylcholine receptor antibody-positive generalized myasthenia gravis. It targets C5 complement, preventing its cleavage into active terminal components. Thus, vaccination against encapsulated organisms is advised before starting this treatment. C5 also has a critical role against Cryptococcus neoformans infection. Here, we present a case of a 34-year-old man with a history of myasthenia gravis who was treated with prednisone and azathioprine in addition to eculizumab that was added to his regimen about a year ago, and who came to the hospital with headache, and was found to have Cryptococcus meningitis with disseminated cryptococcosis. The patient was negative for human immunodeficiency virus. He was treated with antifungal medications, and his condition improved. Although rarely reported, it is important to have a low threshold for diagnosis of cryptococcosis in patients on eculizumab given its complement inhibition mechanism of action.

Keywords: complement c5; cryptococcus neoformans; eculizumab; fungal meningitis; myasthenia gravis (mg).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Head CT
Head CT without contrast showing a normal brain architecture with no acute intracranial pathology.
Figure 2
Figure 2. Head CT
Head CT without contrast showing a normal brain architecture with no acute intracranial pathology.
Figure 3
Figure 3. Brain MRI
Brain MRI with red arrows pointing at bilateral white matter changes thought to be related to an infection or an inflammation.
Figure 4
Figure 4. Brain MRI
Brain MRI with red arrows pointing at bilateral white matter changes thought to be related to an infection or an inflammation.
Figure 5
Figure 5. Brain MRI
Brain MRI with red arrows pointing at bilateral white matter changes thought to be related to an infection or an inflammation.
Figure 6
Figure 6. Head and Neck MRA
MRA of the head and neck showing a normal vasculature of the head and neck with no significant stenosis, occlusion, dissection, or aneurysms found. MRA: magnetic resonance angiography.
Figure 7
Figure 7. Head CT Venogram
CT venogram of the head showing no evidence of dural venous sinus thrombosis.
Figure 8
Figure 8. Head CT Venogram
CT venogram of the head showing no evidence of dural venous sinus thrombosis.
See this image and copyright information in PMC

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