BRAIN and NERVE Shinkei Kenkyu no Shinpo Volume 70, Issue 11 (November 2018)

Cryptococcal Meningitis in a Patient with Breast Cancer Receiving Everolimus: A Case of Successful Treatment with Continuous Cerebrospinal Fluid Drainage Kana Takase 1 , Tatsuya Yoshida 2 , Taishi Nakamura 3 , Shunsuke Seki 1 , Hidemitsu Sato 1 , Tetsuya Yamamoto 3 1Department of Neurosurgery, Kanagawa Cancer Center 2Department of Breast and Endocrine Surgery, Kanagawa Cancer Center 3Department of Neurosurgery, Yokohama City University Keyword: エベロリムス , 乳癌 , クリプトコッカス髄膜炎 , 髄液ドレナージ , Everolimus , breast cancer , cryptococcal meningitis , lumbar drainage pp.1301-1305
Published Date 2018/11/1
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Cryptococcosis is a fungal infection that mainly occurs in immunocompromised patients. We present the first case of cryptococcal meningitis in a patient who was being administered everolimus for breast cancer. Everolimus, a selective inhibitor of mammalian target of rapamycin, is a molecular targeting agent that is administered not only as an immunosuppressive agent, but also as an anticancer therapeutic. A 72-year-old woman with recurrent breast cancer had been receiving everolimus. She was admitted to our hospital with headache and vomiting. Lumbar puncture revealed high opening pressure, and cerebrospinal fluid (CSF) evaluation diagnosed cryptococcal meningitis. She was administered liposomal amphotericin-B, followed by fosfluconazole. Daily lumbar puncture was insufficient to reduce the high intracranial pressure; thus, continuous lumbar drainage was needed to improve her symptoms. The indwelling catheter was replaced regularly to prevent bacterial infection. She was treated successfully with extracorporeal CSF drainage for 86 days and fosfluconazole administration over 17 weeks. The patient recovered fully and was discharged on day 153 of hospitalization. As patients who receive everolimus are potentially immunocompromised hosts, we recommend that the medicine be administered with caution considering opportunistic infections when used in patients with cancer.

(Received April 19, 2018; Accepted August 9, 2018; Published November 1, 2018)

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BRAIN and NERVE-神経研究の進歩
70巻11号 (2018年11月)
電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院