Cryptococcal Infection Following Steroid Therapy

Abstract

A case of cryptococcal infection in a 49-year-old woman who for 9 years had received steroid therapy for rheumatoid arthritis is reported. Features of the case suggested a steroid-enhanced susceptibility to mycosis. A review of the literature in English from 1950 to 1960 was undertaken to determine whether steroid therapy increases susceptibility to cryptococcal infection. Of the reported cases of cryp-tococcosis, 147 had sufficient clinical data for analysis. Of these, 8 (5.4%) occurred during or immediately after steroid therapy. In 3 of these 8 cases there was strong clinical evidence that administration of steroids enhanced the patients'' susceptibility to cryptococcal infection. Of the cases of cryptococcosis analyzed, 9.5% occurred in patients with reticuloendothelial malignancy. This broad category was the only one with an incidence of infection that exceeded that of the steroid therapy group. From these data it is inferred that steroid therapy does enhance susceptibility to cryptococcal infection.