系统性红斑狼疮并发隐球菌性脑膜炎:1例报告并文献复习

目的探讨系统性红斑狼疮(SLE)合并隐球菌性脑膜炎的诊断及鉴别诊断。方法对1例SLE并发隐球菌性脑膜炎患者的临床及实验室检查特点进行分析,并结合文献复习进行讨论。结果患者出现中枢感染前长期使用泼尼松治疗,曾误诊为狼疮脑病应用激素冲击治疗无效;治疗过程中出现狼疮活动,激素加量后症状缓解。结论 SLE并发隐球菌性脑膜炎患者的临床表现缺乏特异性,感染相关症状与SLE表现部分重叠,腰穿脑脊液墨汁染色找隐球菌和隐球菌抗原乳胶凝集试验是诊断的主要手段。及时诊断和有效抗真菌治疗可改善患者的预后。

Cryptococcal meningitis in systemic lupus erythematosus:one case report and literature review

Objective To investigate the diagnosis and discrimination of systemic lupus erythematosus（SLE）complicated with cryptococcal meningitis.Methods One case of cryptococcal meningitis in SLE was reported and related literature was reviewed.Results The patient was treated by prednisone for a long time before central nervous system infection and misdiagnosed as a neuropsychiatric manifestation of SLE when she failed to respond to shock corticosteroid therapy.Lupus activity occurred during antifungal therapy.The symptoms were relieved after corticosteroid dosage increasing.Conclusions As the clinical findings of SLE patients with cryptococcal meningitis are non-specific and misleading,CSF India ink stain and latex agglutination test for cryptococcal antigen should be performed which effective to establish an early diagnosis.Timely diagnosis and antifungal therapy could improve the prognosis of cryptococcal meningitis in SLE patients.