Early Disseminated Cryptococcosis Following Orthotopic Heart Transplantation Requiring VA-ECMO: A Case Report

Disseminated cryptococcosis is a rare but serious opportunistic infection following solid organ transplantation and rarely occurs within the first month of transplantation. We report a case of disseminated Cryptococcus neoformans infection occurring 14 days after orthotopic heart transplantation which required mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Management was complicated by alterations in antifungal pharmacokinetics and the inability to perform serial lumbar punctures while anticoagulated. Antifungal therapy with nonliposomal amphotericin B, flucytosine, and fluconazole was administered. A combination of optic nerve sheath diameter measurements, CT scans, and evaluation for papilledema was used as temporizing, noninvasive surrogates for intracranial pressure monitoring until lumbar punctures could be safely performed. The patient was successfully decannulated, weaned from mechanical support, and discharged from the intensive care unit.