Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis

• Published in: Internal Medicine Vol. 58; no. 21; pp. 3077 - 3082
• Main Authors: Ohyagi, Masaki, Irioka, Takashi, Ohkubo, Takuya, Ishibashi, Satoru, Takahashi, Yuko K, Amano, Eiichiro, Machida, Akira, Kuwahara, Hiroya, Yokota, Takanori
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.11.2019; Japan Science and Technology Agency
• Subjects: Adult; Aged; Aged, 80 and over; autoimmune diseases; Biomarkers - metabolism; Cerebrospinal fluid; cryptococcal meningitis; Cryptococcus - immunology; Emergency medical services; Female; HIV; HIV Seronegativity; Human immunodeficiency virus; Humans; immune reconstitution inflammatory syndrome; Immune response; Immunoglobulin G; Immunoglobulin G - cerebrospinal fluid; Immunoglobulin G - metabolism; Internal medicine; Lesions; leukoencephalopathy; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal - immunology; Meningitis, Cryptococcal - pathology; Meningoencephalitis; Middle Aged; Morbidity; Neuroimaging; Neurology; NMR; Nuclear magnetic resonance; Original; Patients; Retrospective Studies; Substantia alba; White Matter - pathology; autoimmune diseases; leukoencephalopathy; immune reconstitution inflammatory syndrome; cryptococcal meningitis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.2338-18

Objective Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation remain unknown. We herein report the relationship between the intrathecal immune response and the development of WMLs in HIV-negative patients with CM. Methods Eleven consecutive HIV-negative patients with CM who presented at one of three emergency hospitals in Japan from April 2001 to March 2018 were enrolled. For all patients, we retrospectively assessed the relationships between clinical and laboratory information and the presence of WMLs. Results At presentation, 6 patients had WMLs on magnetic resonance imaging (MRI). The cerebrospinal fluid immunoglobulin G (CSF IgG) index was significantly higher in the patients with WMLs than in those without WMLs (mean, 1.34 vs. 0.70, p=0.017). The time from the symptom onset to initial neuroimaging was also significantly longer in the patients with WMLs than in those without WMLs (median, 31.5 vs. 7.0 days; p=0.008). The clinical outcome was comparable among the patients with and without WMLs. Conclusion In HIV-negative patients with CM, a persistent, aberrant immune response to Cryptococcus, such as intrathecal IgG synthesis, may induce WML formation.