Cryptococcal Infection in Transplant Kidney Manifesting as Chronic Allograft Dysfunction

Area of Science:

• Infectious Diseases
• Transplantation Immunology
• Nephrology

Background:

• Invasive fungal infections (IFIs) are a major cause of morbidity in solid organ transplant (SOT) recipients.
• While antifungal prophylaxis has reduced IFIs, Cryptococcal infections remain a challenge due to lack of effective prophylaxis.
• Cryptococcal infections manifest differently in immunocompromised hosts, often affecting the central nervous system, but can occur in other sites.

Observation:

• Cryptococcal infection manifestations differ between immunocompetent and immunocompromised hosts.
• In immunocompetent hosts, infections are often subclinical and self-limiting, primarily affecting the lungs.
• In immunocompromised hosts, the central nervous system is the most common site, with other potential sites including skin, lungs, urinary tract, and bone.

Findings:

• A rare case of biopsy-proven Cryptococcal infection in a transplanted kidney is presented.
• The infection manifested as chronic allograft dysfunction in a young adult renal transplant recipient.
• This presentation is unusual as the kidney is not a typical primary site for Cryptococcus in transplant recipients.

Implications:

• This case underscores the challenge of preventing Cryptococcal infections in SOT recipients.
• It highlights the potential for atypical presentations of Cryptococcus in transplant patients.
• Further research into effective antifungal prophylaxis for Cryptococcus in SOT recipients is warranted.