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CASE REPORT
Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm
  1. Vivek Sood,
  2. Navin Pattanashetti,
  3. Raja Ramachandran and
  4. Krishan Lal Gupta
  1. Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Professor Krishan Lal Gupta, klgupta{at}hotmail.com

Abstract

Cryptococcal infection constitutes around 3% of opportunistic infections in solid organ transplant recipients. Most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis (CME). Ischaemic stroke as a consequence of cryptococcal meningoencephalitisis rare and possibly due to the involvement of intracranial vessel by exudates causing vasculitis-related thrombosis. In this context, we describe an unusual case of asymptomatic cryptococcaemia in an RTR, progressing on to acute ischaemic stroke secondary to acute CME with near complete neurological recovery following timely diagnosis, early and appropriate antifungal treatment. The index case attempts to re-emphasise the significance of mandatory screening required to exclude the possibility of dissemination of cryptococcaemia in RTRs besides highlighting the requirement of prolonged induction phase with combination therapy, particularly in presence of stroke.

  • cryptococcus
  • meningitis
  • vasculitis
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Footnotes

  • Contributors VS and NP: writing, concept and image acquisition. RR and KLG: proof reading and corrections.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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