Sepsis with cerebral lupus…. or is it? A case report on Cryptococcaemia

We present a patient with SLE, with multiple comorbidities, whose blood cultures yielded Cryptococcus neoformans. Blood cultures became positive only after twelve days of hospital admission. The patient died within two days of starting Amphotericin B. Cryptococci are an important cause of infection in SLE. Only about 10% to 30% of those with cryptococcal disease have the organism isolated by blood cultures. Due to its non-specific clinical presentation, cryptococcal infection in SLE can be misdiagnosed as psychosis due to steroids, cerebral lupus and infections due to other non-fungal pathogens. This may lead to inappropriate therapy and delays in administration of antifungal agents. Therefore, cryptococcal infection should be considered when SLE patients present with sepsis irrespective of the presence of features of meningism