Unusual late presentation of cryptococcal meningitis with simultaneous CMV antigenemia in a kidney transplant recipient.

IF 1 Q4 UROLOGY & NEPHROLOGY CEN Case Reports Pub Date : 2024-10-17 DOI:10.1007/s13730-024-00939-2
Tsz Hing Mok, Li Man Maggie Lam, Chi Yuen Cheung
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Abstract

Cryptococcosis is the third most common invasive fungal infection in solid-organ transplant (SOT) recipients after candidiasis and aspergillosis. These patients are at risk of disseminated cryptococcosis because of immuosuppressive therapy. The median time to disease onset after kidney transplantation is approximately 35 months and it rarely occurs more than 10 years after transplantation. Herein, we report a case of 64-year-old kidney transplant recipient suffering from coexisting disseminated cryptococcosis with brain and skin involvement, together with cytomegalovirus (CMV) antigenemia more than 20 years after transplant. She presented with frontal headache and bilateral hand tremor, in addition to multiple nodular lesions over bilateral lower limbs. The diagnosis was made after lumbar puncture and skin biopsy. She was successfully treated with a course of anti-fungal and anti-CMV regimen without any relapse of central nervous system infection. Our case illustrates that disseminated cryptococcosis can occur very late after organ transplant. It is thus important to watch out for late-onset opportunistic infections and strike the balance between risks of infections and rejections in SOT patients.

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一名肾移植受者罕见地晚期出现隐球菌脑膜炎,同时伴有 CMV 抗原血症。
在实体器官移植(SOT)受者中,隐球菌病是继念珠菌病和曲霉菌病之后第三大最常见的侵袭性真菌感染。由于接受了免疫抑制治疗,这些患者有可能感染播散性隐球菌病。肾移植后发病的中位时间约为 35 个月,很少在移植后 10 年以上发病。在此,我们报告了一例 64 岁的肾移植受者在移植后 20 多年同时患有播散性隐球菌病,脑部和皮肤受累,并伴有巨细胞病毒(CMV)抗原血症。她除了双下肢多发结节性病变外,还伴有额部头痛和双侧手震颤。腰椎穿刺和皮肤活检后确诊。经过一个疗程的抗真菌和抗 CMV 治疗后,她的中枢神经系统感染没有复发。我们的病例说明,播散性隐球菌病可能在器官移植后很晚才发生。因此,必须警惕晚期机会性感染,并在 SOT 患者的感染和排斥风险之间取得平衡。
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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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