Published online May 27, 2020. doi: 10.4254/wjh.v12.i5.253
Peer-review started: December 18, 2019
First decision: January 19, 2020
Revised: January 24, 2020
Accepted: April 18, 2020
Article in press: April 18, 2020
Published online: May 27, 2020
Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans (C. neoformans) species complex. These fungi are ubiquitous in soil and bird droppings, and infection by them is an important global health concern, particularly in immunosuppressed patients, such as organ transplant recipients and those infected by the human immunodeficiency virus. The fungus usually enters the body through the respiratory tract, but extremely rare cases of infection acquired by transplantation of solid organs have been reported.
We report a case of disseminated cryptococcosis in a liver transplant recipient, diagnosed 2 wk after the procedure. The patient initially presented with fever, hyponatremia and elevated transaminase levels, manifesting intense headache after a few days. Blood cultures were positive for C. neoformans. Liver biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous formations. Magnetic resonance imaging of the brain showed multiple small lesions with low signal in T2, peripheric enhancement and edematous halo, diffuse through the parenchyma but more concentrated in the subcortical regions. Treatment with amphotericin B for 3 wk, followed by maintenance therapy with fluconazole, led to complete resolution of the symptoms. The recipients of both kidneys from the same donor also developed disseminated cryptococcosis, confirming the transplant as the source of infection. The organ donor lived in a rural area, surrounded by tropical rainforest, and had negative blood cultures prior to organ procurement.
This case highlights the risk of transmission of fungal diseases, specifically of C. neoformans, through liver graft during liver transplantation.
Core tip: Transmission of cryptococcosis through a liver graft during transplantation is an exceedingly rare occurrence, with less than 10 cases reported in the literature. Many of these patients either died or were followed for only a short period of time prior to the report, so there is little information about long term follow-up of patients with this condition. We report the case of a patient who acquired disseminated cryptococcosis from a liver graft during transplantation and was successfully treated, along with the results of follow-up biopsies and imaging exams up to 3.5 years after the transplant.