Case Report: Cryptococcal Infection in Renal Transplant Patient

Abstract

A significant portion of all invasive fungal infections in solid organ transplants are due to cryptococcus. It can be a debilitating infection and affects the quality of life in transplant patients. We report a case of a 57-year-old male patient with recent kidney transplant, who presented with cryptococcal meningitis, after exposure to birds during a trip to Mexico 1 week ago. In addition to a two-day history of generalized weakness, dizziness, intermittent fever, and lightheadedness, the patient presented with on and off headaches, increased sinus pressure, neck stiffness, clogged ear sensation, confusion, and night sweats. The patient was initially treated empirically with fluconazole. Lumber punctuation showed elevated opening pressure, increased WBC, with neutrophil predominance. Cryptococcal antigen tests were positive in both serum and cerebrospinal fluid sources. After confirmation from CSF analysis, he was administered liposomal amphotericin B and flucytosine. Patient’s symptoms rapidly improved. Due to his immunocompromised state, the patient will require lifelong fluconazole maintenance therapy. Even though kidney transplant recipients have a positive outcome in terms of longevity, they are at increased risk of post-transplant infection, such as zoonotic infections. Therefore, in any recent kidney transplant patient with meningitis symptoms, cryptococcal meningitis should always be considered. We report the appropriate criteria, procedures, and tests that allow for a cryptococcal meningitis diagnosis in immunocompromised patients.