Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report

Abstract

BACKGROUND

Through continuous improvement in transplantation medicine, a wider range of solid organ transplant (SOT) recipients is considered suitable for complex procedures. Despite advances in modern transplantation practice, transpiring invasive fungal infections pose a substantial threat for SOT recipients. To our knowledge, cryptococcal infection confined amidst sole pancreas SOT recipients has not been described to date. Enforcement of a multidisciplinary transplant team approach in the management of pancreas SOT recipients presenting with complex cryptococcal complications is fundamental in improving patient outcomes.

CASE SUMMARY

We present the case of a female pancreas transplant recipient, with confirmed meningeal cryptococcosis, referred to our institution for further evaluation and treatment from the Regional Center for Infectious Diseases. On admission, the patient was weaned from the protocolized immunosuppression therapy for two consecutive weeks, in addition to tapering systemic corticosteroid remedial treatment. Our novel multidisciplinary transplant team approach embodied exhaustive discussions of possible complex and diverse multiple organ system physiologic and pathologic challenges associated with distinct management strategies in pancreas transplant recipients. Owing to the potentially devastating impact of invasive cryptococcosis in terms of morbidity and mortality, a definitive surgical intervention of pancreas transplant grafectomy was reinforced, as a pathway towards secure access to early meaningful expertise care. The patient was discharged to the Regional Center for Infectious Diseases 2 mo after the admittance further advancing to a clinical improvement.

CONCLUSION

The precision transplantation approach by tailoring complex medical interventions to individual needs proved indispensable in improving our patient’s outcomes.

Keywords: Solid organ transplantation; Pancreas transplantation; Complications; Meningeal cryptococcosis; Management; Grafectomy; Case report

Core Tip: The morbidity and mortality arising from invasive cryptococcosis in solid organ transplant recipients are an incentive to establish the lowest possible level of immunosuppression necessary to maintain stable graft function. There is a paucity of data on optimum management strategies and the absence of standard transplantation protocols for the complex subgroup of pancreas organ transplant recipients with invasive cryptococcosis. This short report demonstrates that the intervention of pancreas transplant grafectomy might be an effective surgical treatment option for pancreas transplant recipients with meningeal cryptococcosis, as a path towards securing good outcomes.