ESPN 51th Annual Meeting

ESPN 2018


 
CRYPTOCOCCAL PNEUMONIAE IN A KIDNEY TRANSPLANT PATIENT
İPEK KAPLAN BULUT 1 SEVGIN TANER 1 CEMALIYE BASARAN 2 BETÜL EKICI 3 CANER KABASAKAL 1

1- EGE UNIVERSITY FACULTY OF MEDICINE, PEDIATRIC NEPHROLOGY
2- UNIVERSITY OF HEALTH AND SCIENCES, DR. BEHCET UZ CHILDRENS HOSPITAL, PEDIATRIC NEPHROLOGY
3- EGE UNIVERSITY FACULTY OF MEDICINE, PEDIATRICS
 
Introduction:

Cryptococcosis is a significant opportunistic infection in solid organ transplant recipients. 

Material and methods:

 We herein present a case of C. neoformans pneumonia with a renal transplant patient.

Results:

Case:

An 18-year-old male patient, 6 years renal transplant from his mother, admitted to hospital due to increase in creatinine. On physical examination, there was no finding other than recently developed hypertension and operation scar in his abdomen. Urea (155 mg/dL), creatinine (1.49 mg/dL), CRP (0.14 g/dL) were found increased from previous normal values. Renal doppler USG revealed increased renal parenchymal echogenicity. Immunosuppressive drug levels also were in normal range (Cyclosporin C0:147 ng/mL). Renal biopsy was consistent with acute rejection and treatment was started. Fever appeared on the following week; physical examination was almost normal. His WBC:3130x10³/μL, plt:88x10³/μL, CRP:19 mg/dL. Immunosuppressants doses were reduced; antibiotic treatment started empirically. HRCT revealed septal thickening, multiple lymphadenopathies, and pleural effusion. C. neoformans was detected in blood culture. Detailed history revealed the patient was pigeon feeder. Family did not consent lumbar puncture. Amphotericin B and fluconazole was started. On follow up BPAP was needed owing respiratory distress. Blood culture became negative on the 13th day of treatment. The treatment of the patient was completed in six weeks with four weeks dual antifungal therapy. Urea and creatinine were 77 mg/dL and 1.7 mg/dL respectively at discharge.  

Conclusions:

We would like to remind, Cryptococus neoformans is an opportunistic fungal infection with high mortality without appropriate treatment in renal transplant patients. Noncompliance may cause major problems in adolescents.