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A novel presentation of cryptococcal infection in a renal allograft recipient
K A Abraham1, M A Little, R Casey
1Department of Nephrology, Beaumont Hospital, Dublin.
Insights
This case report details the first Irish instance of primary cryptococcal cellulitis in an immunosuppressed renal transplant patient. Early recognition and treatment with fluconazole led to complete healing, highlighting the need for vigilance against atypical infections.
Area of Science:
- Mycology
- Infectious Diseases
- Immunology
Background:
- The increasing population of immunosuppressed individuals, due to HIV and organ transplantation, leads to a rise in opportunistic infections.
- Atypical infections can present as common conditions, posing diagnostic challenges in immunocompromised patients.
Observation:
- A 62-year-old renal transplant recipient presented with hand cellulitis unresponsive to antibiotics.
- Clinical examination revealed localized tissue necrosis without systemic signs of infection.
Findings:
- Histopathology of debrided tissue showed granulomas and yeast forms consistent with Cryptococcus neoformans.
- Cryptococcus neoformans was successfully cultured from the surgical specimen.
- The patient achieved complete healing with oral fluconazole treatment.
Implications:
- This case underscores the importance of considering unusual pathogens, such as Cryptococcus neoformans, in immunocompromised patients with seemingly common infections.
- Early diagnosis and appropriate antifungal therapy are crucial for successful management and preventing recurrence.
- Clinicians should maintain a high index of suspicion for atypical infections in this vulnerable patient population.
Abstract:
The population of immunosuppressed patients is growing rapidly because of the HIV epidemic and the rapid expansion in transplant medicine. These patients may present to a variety of clinical specialties with seemingly innocuous infections. We present here the first Irish case of primary cryptococcal cellulitis. The patient was a 62-year old renal transplant recipient and was immunosuppressed with Cyclosporine, Azathioprine and Prednisolone. He presented with an apparent bacterial cellulitis on the dorsum of the hand that had failed to respond to a 3-week course of oral antibiotics. There was no clinical evidence of systemic infection. There was tissue necrosis present and the area was debrided surgically. Histological examination of debrided tissue revealed necrotic granulomata and budding yeast-like organisms. Cryptococcus neoformans was cultured from this specimen. The patient was treated with oral fluconazole 400 mg daily for 6 weeks with complete healing of the infected area and no evidence of recurrence after 12 months of follow up. This case emphasises the need for a high index of suspicion for atypical infection in the immunocompromised patient.
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