Cryptococcal meningitis after renal transplant - a case report and review of literature
Yuan-Cheng Chu, Yang-Jen Chiang
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan
Infections are major determination of outcome in organ transplantation. Opportunistic infections are common in patients who is under immunosuppression medication after renal transplantation. Invasive fungal infection has been reported to be an important cause of morbidity and mortality in renal transplant recipients.
We report a case of Cryptococcus neoformans related meningtitis two years after renal transplantation. This is a 66-year-old female patient who received renal transplantation in 2012/12 and receiving immunosuppressive therapy. The initial presentation were progressive general weakness and anorexia for one month. There was no obvious febrile episode nor other neurologic signs. The laboratory test showed no leukocytosis and no evidence of bacterial infection. However, spiking fever was noted after admission. After empiric antibiotic treatment, the fever persisted. Rapid diagnosis was based on blood sample of Cryptococcus spp antigen and cerebrospinal fluid culture showed Cryptococcus neoformans. After anti-fungal medication, her symptoms improved and still followed up in outpatient clinics.
The initial presentation of invasive fungal infection is a challenge to clinical physician. Physician should always consider the possibility of invasive fungal infection in patients under immunosuppressive medication.