A case report of systemic cryptococcosis with Lennert's lymphoma:A clinical significance of C. neoformans antigen titer in the serum

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We report here a case of systemic cryptococcosis with Lennert's lymphoma. The significance of the titer of the antigen and antibody of Cryptococcus neoformans was studied throughout the clinical course of the patient.The patient, a 42-year-old female, was admitted to Tsukuba University Hospital in November, 1980, because of fever and skin rash. She had widespread skin rash and lymphadenopathy, and hepato-splenomegaly. A diagnosis of Lennert's lymphoma was made from the patholopy of the biopsy specimen of her right cervical lymphnode. The clinical stage of the disease was IVB. The eight courses of combination chemotherapy brought about a little effect on the disease. However, she subsequently had a sudden onset of high fever, with a severe headache and nausea and further, different, skin rash on the face. C. neoformans were detected from venous blood, cerebrospinal fluid (CSF) and skin secretion. A diagnosis of systemic cryptococcosis was made. She was simultaneously given amphotericin B intravenously and intrathecally for 3 weeks. Thereafter she was further treated with intrathecal amphotericin B for 6 weeks and oral flucytosine for 7 months. Her cryptococcal meningitis immediately improved following the start of the initial therapy. Two months later all the cultures of C. neoformans from CSF, blood and skin secretion was negative. She completely recovered from cryptococcosis and lymphoma and was still well on March 30, 1985.The antigen titer of C. neoformans in her serum and CSF was serially measured by latex particle agglutination method and the antibody titer by slide agglutination test from December, 1980 to July, 1983. Antigen titer in the serum was negative until 2 weeks prior to the diagnosis of cryptococcosis. The antigen titer was very high when meningitis occured but gradually fell as meningitis recovered clinically. The antibody was never detected in serum and CSF.These results suggest the following conclusions: 1. C. neoformans antigen titer in the serum indicated the state of systemic cryptococcosis. The titer is, therefore, valuable for the diagnosis and prognosis of the disease.2. The inability to detect C. neoformans antibody in both her serum and CSF indicates the antibody titer may not be of clinical value in immunodeficient patients.

A case report of systemic cryptococcosis with Lennert's lymphoma:A clinical significance of C. neoformans antigen titer in the serum

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