A 17-year-old woman with SLE.
At the time of diagnosis she presented with a lupus nephritis manifested by nephrotic syndrome, with 24-hour urine protein of 3.3 g, cholesterolemia of 280 mg% and albuminuria of 1.8 g.
The patient also had severe headache that partially calmed with analgesics and no signs of meningeal irritation, which was interpreted as a symptom associated with lupus.
She remained hospitalized for renal biopsy, but the patient abandoned the hospital contradicting her medical opinion and continued treatment with prednisone up to 15 days after her return to hospital, when she dropped to a 35 mg dose.
One month later, the patient returned to the hospital for follow-up and agreed to be admitted for renal biopsy.
Examinations showed impaired renal function, associated with impure nephrotic syndrome, with hypertension (160/110).
The prednisone dose was increased to 1 mg/kg/day and captopryl 50 mg was added every 8 hours.
The patient reported a persistent oppressive frontoparietal headache of strong intensity that no longer improved with analgesics and was exacerbated by head movements, without other signs and associated symptoms.
He suffered a CNS vasculitis.
A few days after admission the patient developed fever of 40 °C, nausea, vomiting and photophobia.
A lumbar puncture was performed, obtaining CSF at an initial pressure of 37 cm H2O and a final pressure of 16 cm H2O, of turbidity, colorless appearance, with 0 cquial/mm3, glucose + 76.4 mg
Direct Gram stain showed abundant blastospores and staining with Chinese ink was positive for encapsulated yeasts.
Both CSF and blood cultures were positive for C. neoformans.
Corticosteroid therapy was discontinued and amphotericin B deoxycholate therapy was initiated at a dose of 0.7 mg/kg/day.
Upon reaching a cumulative dose of 1 gram, full recovery was observed.
After obtaining a negative CSF culture, treatment was initiated with cyclophosphamide i.v. (500 to 1,000 mg monthly) and low-dose corticosteroids for the management of their nephropathy.
