Abstract:

A 7-year-old child of Turkish origin presented with headache and vomiting in the context of prolonged fever of unknown source. At examination, oral candidiasis and chronic onychomycosis were noted. A Candida meningoencephalitis was diagnosed and intravenous Amphotericin B liposomal was given during 6 months relayed by oral Fluconazole after regression of CNS lesions was observed on MRI. A complete immune evaluation was performed, and genetic analysis detected homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients. Culture of the cerebrospinal fluid grew for multisensitive Candida albicans. Brain magnetic resonance (MRI) showed the presence of focal lesions in the left caudate nucleus and in the right cerebellar hemisphere. Medullar MRI showed diffuse meningeal nodular lesions. Treatment with intravenous amphotericin B liposomal was given during 6 months relayed by oral fluconazole after regression of CNS lesions was observed on MRI. A complete immune evaluation was performed and genetic analysis detected a homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients.

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A 7-Year-Old Child With Headaches and Prolonged Fever Associated With Oral and Nail Lesions

Christiane Vermylen+5 authors

^{General Pediatrics, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium}

^{General Pediatrics, Hôpital de Jolimont, La Louvière, Belgium}

^{Neuropediatrics, Cliniques universitaires Saint-Luc, Brussels, Belgium}

^{Pediatrics and Neonatology, Clinique Saint-Jean, Brussels, Belgium}

^{Pediatric Hematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium}

^{Department of Immunology and Rheumatology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada}

^{Pediatric Infectious Diseases, General Pediatrics, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium}

^{Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Imagine Institute, Paris, France}

^{Pediatric Immunology and Rheumatology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium}

^{Institut de Recherche Clinique et Expérimentale, UCLouvain, Brussels, Belgium}

Correspondence: D. Van der Linden, Avenue Hippocrate, 10, 1200 Brussels, Belgium (eb.niavuolcu@nednilrednav.irtimid).

Received 2019 May 13; Accepted 2019 Jul 3.

Copyright © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Abstract

A 7-year-old child of Turkish origin presented with headache and vomiting in the context of prolonged fever of unknown source. At examination, oral candidiasis and chronic onychomycosis were noted. A Candida meningoencephalitis was diagnosed and intravenous Amphotericin B liposomal was given during 6 months relayed by oral Fluconazole after regression of CNS lesions was observed on MRI. A complete immune evaluation was performed, and genetic analysis detected homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients.

Culture of the cerebrospinal fluid grew for multisensitive Candida albicans. Brain magnetic resonance (MRI) showed the presence of focal lesions in the left caudate nucleus and in the right cerebellar hemisphere. Medullar MRI showed diffuse meningeal nodular lesions. Treatment with intravenous amphotericin B liposomal was given during 6 months relayed by oral fluconazole after regression of CNS lesions was observed on MRI.

A complete immune evaluation was performed and genetic analysis detected a homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients.

Keywords: CARD9 deficiency, chronic mucocutaneous candidiasis, eosinophilic meningitis, meningoencephalitis

Abstract

References

1. Pappas PG, Kauffman CA, Andes DR, et al Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1–50. [Google Scholar]
2. Lanternier F, Mahdaviani SA, Barbati E, et al Inherited CARD9 deficiency in otherwise healthy children and adults with Candida species-induced meningoencephalitis, colitis, or both. J Allergy Clin Immunol 2015; 135:1558–68.e2. [Google Scholar]
3. Zhong X, Chen B, Yang L, Yang Z. Molecular and physiological roles of the adaptor protein CARD9 in immunity. Cell Death Dis 2018; 9: 52.
4. Roth S, Ruland J. Caspase recruitment domain-containing protein 9 signaling in innate immunity and inflammation. Trends Immunol 2013; 34:243–50. [[PubMed]
5. Corvilain E, Casanova JL, Puel A. Inherited CARD9 deficiency: invasive disease caused by ascomycete fungi in previously healthy children and adults. J Clin Immunol 2018; 38:656–93.

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