Cryptococcal cerebrospinal fluid shunt infection treated with fluconazole

Area of Science:

• Nephrology
• Infectious Diseases
• Neuroscience

Background:

• Renal transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections like fungal meningitis.
• Intracranial shunting devices, used for managing cerebrospinal fluid issues, may pose risks for infection in transplant patients.

Observation:

• A 37-year-old female renal transplant recipient developed cryptococcal meningitis six months after presumptive tuberculous meningitis and placement of intracranial shunting devices.
• The patient presented with culture-proven cryptococcal meningitis.
• The ventriculo-auricular shunt was not removed during treatment.

Findings:

• Successful treatment of cryptococcal meningitis was achieved with a combination of amphotericin B and flucytosine, followed by oral fluconazole.
• Treatment was effective despite the presence of the ventriculo-auricular shunt.
• The patient experienced no relapse of cryptococcal meningitis three years post-treatment.
• Renal graft function remained normal throughout the follow-up period.

Implications:

• This case demonstrates the feasibility of treating cryptococcal meningitis in a renal transplant patient with an indwelling intracranial shunt using standard antifungal regimens.
• It suggests that shunt removal may not always be necessary for successful management of fungal meningitis in this population.
• The findings support the efficacy of combined and sequential antifungal therapy in preventing relapse and preserving graft function in immunocompromised hosts with central nervous system fungal infections.