Disseminated Cryptococcosis After Liver Transplant: A Case Report

Exp Clin Transplant. 2020 Jun;18(3):402-406. doi: 10.6002/ect.2018.0051. Epub 2019 Jan 29.

Abstract

Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Cryptococcosis / diagnosis
  • Cryptococcosis / drug therapy
  • Cryptococcosis / immunology
  • Cryptococcosis / microbiology*
  • Female
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Liver Transplantation / adverse effects*
  • Lung Diseases, Fungal / diagnosis
  • Lung Diseases, Fungal / drug therapy
  • Lung Diseases, Fungal / immunology
  • Lung Diseases, Fungal / microbiology*
  • Lymphadenitis / diagnosis
  • Lymphadenitis / drug therapy
  • Lymphadenitis / immunology
  • Lymphadenitis / microbiology*
  • Meningitis, Cryptococcal / drug therapy
  • Meningitis, Cryptococcal / immunology
  • Meningitis, Cryptococcal / microbiology
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / immunology
  • Opportunistic Infections / microbiology*
  • Sacroiliitis / diagnosis
  • Sacroiliitis / drug therapy
  • Sacroiliitis / immunology
  • Sacroiliitis / microbiology*
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Immunosuppressive Agents