[CIS PIDD] [cis-pidd] 53yoM with cryptococcal meningitis

[Temino, Viviana M.]

I am looking for help with the workup of a patient with cryptococcal meningitis which is either recurrent or poorly responsive to treatment.  I have included a brief clinical summary and labs below.  Any advice on further testing that would be appropriate would be appreciated.  IgG and IgM to cryptococcal antigen has not been done yet to my knowledge.

53 year old man who has no known immunodeficiency and no prior significant infections (no sinusitis, GI infections/giardiasis, meningitis/encephalitis, sinusitis, pneumonia or skin infections/abscesses) who presented in November 2013 with altered mental status and seizures.  Diagnosed with cryptococcal meningitis at that time and was treated with amphotericin, fluconazole and voriconazole.  He may have had some lapses in treatement/poor compliance due to intolerance to medications and since then has had further imaging with signs that the cryptococcal meningitis has been progressing/worsening and has now developed disseminated disease (hematologic and possibly skin).

Lab workup includes:
HIV- negative
Immunoglobulin profile- normal
Response to pneumovax- normal
Tetanus titer undetectable (no response checked as of yet)
ANCA negative
Complement (C3, C4, CH50, AH50) normal
Lymphocytes (B cells, NK cells and immunophenotypically normal DC4+ and CD8+ T cells) in normal proportions
Granulocytes immunophenotypically mature


Thank You,

Lauren Fine
Assistant Professor of Allergy, Asthma & Immunology
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
University of Miami Miller School of Medicine
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