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Reduced Itraconazole Concentration and Durations Are Successful in Treating Batrachochytrium dendrobatidis Infection in Amphibians

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Plasma exchange for disseminated cryptococcosis.

Guillaume Bollée¹, Maxime Touzot, Fredéric Mechai

¹Department of Nephrology, AP-HP, Hôpital Necker, Université Paris V, Paris, France.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|October 14, 2008

Summary

Acute renal failure in HIV patients can stem from various causes. This case highlights disseminated cryptococcosis causing kidney failure via blocked capillaries, successfully treated with plasma exchange.

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Area of Science:

Nephrology
Infectious Diseases
Immunology

Background:

Acute kidney injury (AKI) is a common complication in human immunodeficiency virus (HIV)-infected individuals.
Potential causes include HIV-associated nephropathy, nephrotoxic medications, and opportunistic infections.
Disseminated fungal infections can precipitate severe systemic illness in immunocompromised hosts.

Observation:

A unique case of disseminated cryptococcosis in an HIV-infected patient presented with severe acute renal failure.
Renal impairment was attributed to intrarenal capillary obstruction by Cryptococcus neoformans.
The patient's condition was successfully managed using plasma exchange therapy.

Findings:

Cryptococcus neoformans, even in its non-viable form, can cause significant renal pathology.
Plasma exchange effectively removed the obstructing fungal debris, leading to renal recovery.
This case underscores the importance of considering unusual etiologies for AKI in HIV patients.

Implications:

Highlights a novel mechanism of acute renal failure in disseminated cryptococcosis.
Demonstrates the therapeutic potential of plasma exchange in managing specific forms of fungal-induced kidney injury.
Suggests a need for broader diagnostic considerations for AKI in immunocompromised populations.