Candida dubliniensis meningitis in an immunocompetent patient: A case report and review of the literature

TL;DR

A 22-year-old immunocompetent woman developed Candida dubliniensis meningitis, possibly linked to prior ECMO treatment, highlighting the need for repeat lumbar punctures in such cases.

Contribution

This case report suggests ECMO as a potential risk factor for C. dubliniensis colonization in immunocompetent individuals.

Findings

Candida dubliniensis meningitis occurred in an immunocompetent patient with prior ECMO use.

Repeat lumbar puncture and CSF analysis were crucial for diagnosing fungal meningitis.

Injecting drug use and hepatitis C are proposed as additional risk factors.

Abstract

We present the fifth case of candida dubliniensis meningitis in a young immunocompetent host and suggest extracorporeal membrane oxygenation (ECMO) as a potential risk factor for colonization.

A 22-year-old immunocompetent female presented with a diagnosis of bacterial meningitis. Two years prior, she received ECMO for Covid-19 pneumonia complicated by viral myocarditis & Takutsobo cardiomyopathy. Following discharge, she reported headaches of increasing intensity, all refractory to treatments. Brain magnetic resonance imaging (MRI) was inconclusive. Two weeks prior to her presentation, she was admitted for worsening headaches with cranial nerve VI palsy. Lumbar puncture (LP) revealed white blood cell count (WBC) of 166 cells/μL with neutrophilic predominance and her symptoms progressed, despite 5 days of treatment with broad spectrum antibiotics. All cultures returned negative.

At her current presentation, repeat LP revealed 835 WBC/mm3, 225 mg/dL protein, and 4 mg/100 mL glucose. Brain MRI revealed nodular enhancement in the brainstem and communicating hydrocephalus. MRI of the lumbar spine revealed meningeal enhancement. Cerebrospinal fluid (CSF) cultures came back positive for C.dubliniensis. Treatment began with Amphotericin B and Flucytosine.

When clinical suspicion for fungal meningitis is high, repeate LP and CSF analysis is indicated to establish a definitive diagnosis and begin treatment. Additional studies are needed to confirm risk factors, like ECMO, for the colonization of C.dubliniensis, which likely predisposes individuals to invasive candidiasis.

•C. Dubliniensis is a predominantly opportunistic pathogen in immunocompromised host.•ECMO may be a risk factor for C. dubliniensis colonization in immunocompetent hosts.•Repeat LP and CSF is indicated to diagnosis C. dubliniensis in immunocompetent host.•Injecting drug use and hepatitis C maybe additional risk factors.

C. Dubliniensis is a predominantly opportunistic pathogen in immunocompromised host.

ECMO may be a risk factor for C. dubliniensis colonization in immunocompetent hosts.

Repeat LP and CSF is indicated to diagnosis C. dubliniensis in immunocompetent host.

Injecting drug use and hepatitis C maybe additional risk factors.

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