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Fatal Cryptococcal Meningitis in a Patient With Chronic Lymphocytic Leukemia Treated With Ibrutinib.

التفاصيل البيبلوغرافية
العنوان: Fatal Cryptococcal Meningitis in a Patient With Chronic Lymphocytic Leukemia Treated With Ibrutinib.
المؤلفون: Oumayma H; Hematology Department, Military Hospital, Rabat, MAR., Mahtat EM; Hematology Department, Military Hospital, Rabat, MAR., Moussa Bouh H; Hematology Department, Military Hospital, Rabat, MAR., Elmaaroufi H; Hematology Department, Military Hospital, Rabat, MAR., Doghmi K; Hematology Department, Military Hospital, Rabat, MAR.
المصدر: Cureus [Cureus] 2023 Apr 20; Vol. 15 (4), pp. e37891. Date of Electronic Publication: 2023 Apr 20 (Print Publication: 2023).
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Palo Alto, CA : Cureus, Inc.
مستخلص: According to the latest World Health Organization classification published in 2022, chronic lymphocytic leukemia (CLL) is classified as a low-grade proliferation of clonal B-cells. The Bruton tyrosine kinase (BTK) pathway plays a crucial role in B-cell receptor signaling. Ibrutinib, the first irreversible BTK inhibitor, has been shown to improve the survival of CLL patients with lower toxicity than traditional chemotherapy. Cryptococcosis is an invasive fungal infection that primarily affects individuals with compromised immune systems. We present a case of a 69-year-old male with relapsed CLL who received treatment with ibrutinib and subsequently developed meningeal cryptococcosis, presenting with seizures and fever. A physical exam showed bilateral hypoacusis, but no focal deficits. Cerebral imaging was normal and laboratory results showed a low gamma globulin level and leucopenia with lymphopenia but without neutropenia. The cerebrospinal fluid profile was not inflammatory, opening pressure was normal, the classic India ink test was positive, and fungal cultures grew Cryptococcus neoformans . To complete investigations, HIV testing was negative, and sinus and chest tomography scans showed no anomalies. Treatment consisted of discontinuing ibrutinib and administering anti-fungal therapy with liposomal amphotericin (4 mg/kg/day) in combination with flucytosine (25 mg/kg/day). However, the patient's neurological status declined, and he passed away. This case highlights the potential risk of developing opportunistic infections such as cryptococcal meningitis in CLL patients treated with ibrutinib. It is crucial to consider the patient's immune status when administering ibrutinib and to closely monitor for signs of infection.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2023, Oumayma et al.)
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فهرسة مساهمة: Keywords: chronic lymphocytic leukemia; chronic lymphocytic leukemia (cll); cryptococcus neoformans; cryptococcus neoformans (c. neoformans); ibrutinib; meningitis; risk factor
تواريخ الأحداث: Date Created: 20230522 Latest Revision: 20230523
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10199734
DOI: 10.7759/cureus.37891
PMID: 37213990
قاعدة البيانات: MEDLINE
الوصف
تدمد:2168-8184
DOI:10.7759/cureus.37891