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Cryptococcal meningitis presenting as sinusitis in a renal transplant recipient

S P Iyer1, K Movva, M Wiebel

  • 1Department of Medicine, St. John's Medical Center, Detroit, Michigan, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|September 17, 2013
PubMed

Insights

Cryptococcal meningitis, a fungal infection, can present unusually in renal transplant patients. This case highlights successful primary treatment with fluconazole for a patient presenting with sinusitis symptoms.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Nephrology

Background:

  • Cryptococcal meningitis is a significant invasive fungal infection in immunocompromised individuals, particularly solid organ transplant recipients.
  • Standard treatment involves amphotericin B, which poses nephrotoxicity risks in renal transplant patients.
  • Typical symptoms include fever, headache, and neck stiffness, but atypical presentations can occur.

Observation:

  • A renal transplant recipient presented with symptoms mimicking acute sinusitis, delaying the diagnosis of cryptococcal meningitis.
  • The patient's presentation was unusual, deviating from the typical clinical manifestations of cryptococcal meningitis.

Findings:

  • Successful primary treatment of cryptococcal meningitis was achieved using fluconazole.
  • This approach avoided the nephrotoxic effects of amphotericin B in a renal transplant recipient.

Implications:

  • Fluconazole can be an effective primary therapy for cryptococcal meningitis in renal transplant patients, especially when amphotericin B is contraindicated.
  • Recognizing unusual presentations of cryptococcal meningitis, such as sinusitis, is crucial for timely diagnosis and treatment in transplant populations.
Keywords:
Cryptococcusmeningitisrenal transplantationsinusitis

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