CASE REPORT   

Journal of Neurosurgical Sciences 2021 April;65(2):207-10

DOI: 10.23736/S0390-5616.18.04375-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Cryptococcal-related meningoencephalitis in a patient with sarcoidosis and CD4 lymphocytopenia: thorough immunological characterization of lymphocyte homeostasis

Viviana GIUSTINI ¹, Alessandra SOTTINI ¹, Stefano BELLERI ¹, Diego BERTOLI ^{1, 2}, Aldo M. ROCCARO ^{1, 3}, Alessandro MONTANELLI ⁴, Matteo FILIPPINI ⁵, Marco FONTANELLA ⁶, Luisa IMBERTI ¹ ✉

¹ Centro di Ricerca Emato-Oncologica AIL (CREA), Clinical Chemistry Laboratory, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy; ² Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; ³ Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy; ⁴ Clinical Chemistry Laboratory, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy; ⁵ Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy; ⁶ Division of Neurosurgery, ASST Spedali Civili and University of Brescia, Brescia, Italy

Cryptococcal meningoencephalitis is the most common infective complication observed in patients with CD4 lymphocytopenia, including sarcoidosis. T-cell immunity is well characterized in HIV-related infections and data regarding immunity in cryptococcosis animal models is now available; on the contrary, little is known about the immune status in non-HIV-related infections. We report on reduced production of new T cells observed in a patient with sarcoidosis, CD4 lymphocytopenia, and cryptococcal-related meningoencephalitis. Although T cells presented with an intact proliferative capacity, they were oligoclonally expanded showing an effector memory phenotype. However, the deleterious activity of effector memory cells could have been controlled by the expansion of the regulatory T cell subset with the highest suppressive capability. This information provides a better understanding of the immune response to Cryptococcus occurring in non-HIV-associated cases, the predisposition to infection, and the role of different cell subtypes in controlling the disease in humans.

KEY WORDS: Meningoencephalitis; Lymphopenia; Sarcoidosis; Cryptococcosis