Cryptococcal pyelonephritis and disseminated cryptococcosis in a renal transplant recipient

Symptomatic cryptococcal pyelonephritis, meningitis, and disseminated cryptococcosis are described in a renal cadaver transplant recipient who subsequently died of Klebsiella pneumoniae sepsis. The presence of cryptococcuria and a subsequent positive CSF India ink stain led to the initial diagnosis of disseminated cryptococcosis. Therapy with 0.511 g of amphotericin B and 112.5 g of flucytosine for four weeks did not eradicate Cryptococcus from the kidney and was associated with hepatotoxicity. The importance of urinary examination and culture for C neoformans is emphasized. Cryptococcal pyelonephritis should be considered in the differential diagnosis of allograft rejection in the renal transplant patient.