Open AccessDeceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm
Author(s) -
Vivek Sood,
Navin Pattanashetti,
Raja Ramachandran,
Krishan Lal Gupta
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-228115
Subject(s) - medicine , meningoencephalitis , asymptomatic , context (archaeology) , intensive care medicine , stroke (engine) , ischaemic stroke , thrombosis , vasculitis , opportunistic infection , immunology , disease , ischemia , human immunodeficiency virus (hiv) , viral disease , mechanical engineering , paleontology , engineering , biology
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.