Citation Information :
Shastri P, Kumar R, Gupta P. A Rare Case of Combined Pulmonary Cryptococcosis and Cryptococcal Meningitis in Renal Allograft Recipient. Indian J Crit Care Med 2019; 23 (12):587-589.
Invasive cryptococcosis is the third most common invasive fungal infection among organ transplant recipients.1 The most frequently encountered clinical manifestation is cryptococcal meningoencephalitis (CM) which may be easily missed because of varying clinical presentations. 1-year mortality is estimated at 20–30% even with long-term consolidated antifungal therapy. Here we report a case of combined pulmonary and cryptococcal meningitis in a renal allograft recipient. This case illustrates the difficulty of estimating the real extent of the disease when only clinical features are considered. The patient presented with nonspecific symptoms. Chest computed tomography (CT) scans revealed multiple pulmonary nodular shadows. The CT-guided biopsy of the pulmonary nodule clinched the diagnosis of pulmonary cryptococcosis (PC). The central nervous system (CNS) cryptococcosis was proved by positive culture and crypto-LA antigen in the cerebrospinal fluid (CSF).
Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the transplant-associated infection surveillance network (TRANSNET). Clin Infect Dis 2010;50(8):1101–1111. DOI: 10.1086/651262.
Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A, et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol 2017;13(1):13–24. DOI: 10.1038/nrneurol.2016.167.
Hajjeh RA, Conn LA, Stephens DS, Baughman W, Hamill R, Graviss E, et al. Cryptococcosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. Cryptococcal active Surveillance Group. J Infect Dis 1999;179(2): 449–454. DOI: 10.1086/314606.
Singh N, Alexander BD, Lortholary O, Dromer F, Gupta KL, John GT, et al. Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality. J Infect Dis 2007;195(5):756–764. DOI: 10.1086/511438.
Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357(25):2601–2614. DOI: 10.1056/NEJMra064928.
Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis 2001;7(3):375–381. DOI: 10.3201/eid0703.017302.
Wang L, Shi Y, Ding Y, Wang Q, Su X. Pulmonary cryptococcosis: a retrospective analysis of 65 cases. Zhonghua Jie He He Hu Xi Zap Zhi 2014;37(10):764–768.
Jan IS, Cheng WC, Lo SC, Weng MH, Lee LN. Cryptococcus neoformans in sputum and lung aspiration cytology smears. J Microbiol Immunol Infect 2015;48(4):463–464. DOI: 10.1016/j.jmii.2014.02.005.
