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Background:  Colonization of  Cryptococcus  rarely occurs in a graft. This study reports a case of malacoplakia and cryptococcoma caused by  E. coli  and  Cryptococcus albidus  in a transplanted kidney, with detailed pathology and metagenome sequencing analysis.   Case Presentation:  We presented a case of cryptococcoma and malacoplakia in the genitourinary system including the transplant kidney, bladder, prostate, and seminal vesicles caused by  Cryptococcus albidus  and  Escherichia coli  in a renal-transplant recipient. Metagenome sequencing was conducted on a series of samples obtained from the patient at three different time points, which we termed Phase I (at the diagnosis of cryptococcoma), Phase II (during perioperative period of graftectomy, 3 months after the diagnosis), and Phase III (2 months after graftectomy). Sequencing study in the Phase I detected two and four sequences of  C. albidus  respectively in cerebrospinal fluid (CSF) and feces, with resistant  Escherichia coli 09-02E  presented in urine and renal mass. A 3-month antibiotic treatment yielded a smaller bladder lesion but an enlarged allograft lesion, leading to a nephrectomy. In the Phase II, two sequences of  C. albidus  were detected in CSF, while the  E. coli 09-02E  continued as before. In the Phase III, the lesions were generally reduced, with one  C. albidus  sequence in feces only.   Conclusions:  The existence and clearance of  Cryptococcus  sequences in CSF without central nervous system symptoms may be related to the distribution of infection foci  in vivo , the microbial load, and the body's immunity. Overall, this study highlights the need for enhanced vigilance against uncommon types of  Cryptococcus  infections in immunocompromised populations and increased concern about the potential correlation between  E. coli  and  Cryptococcus  infections.

frontiers in medicine

Case Report: Malacoplakia Due to E. coli With Cryptococcus albidus Infection of a Transplanted Kidney in a Patient With Recurrent Urinary Tract Infection