RT Journal Article
SR Electronic
T1 Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e228115
DO 10.1136/bcr-2018-228115
VO 12
IS 4
A1 Vivek Sood
A1 Navin Pattanashetti
A1 Raja Ramachandran
A1 Krishan Lal Gupta
YR 2019
UL http://casereports.bmj.com/content/12/4/e228115.abstract
AB 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.