Hepatic cryptococcosis in a heart transplant recipient

Transplant Infectious Disease : an Official Journal of the Transplantation Society
R UtiliS Esposito

Abstract

Cryptococcosis primarily occurs in patients with impaired immune response. While pulmonary and/or cerebral involvement are more often described, there is limited experience of its presence in other sites. We present a case of hepatic cryptococcosis with possible pulmonary involvement in a 54-year-old male heart transplant recipient. Two months after heart transplantation, he developed a persistent, moderate dyspnea with fever and signs of liver damage. Diagnosis was made with liver biopsy for a concurrent reactivation of chronic hepatitis B virus (HBV) infection already present before transplant. Along with a mild chronic HBV hepatitis with fibrosis, we observed sinusoidal dilation and groups of bright, rounded, colorless cells with a central nucleus suggestive of cryptococci. Periodic acid-Schiff stain clearly showed encapsulated yeasts, which supported the diagnosis. Cryptococcal antigen was positive in serum and negative in the cerebrospinal fluid. Computed tomography scan of the chest demonstrated a mild interstitial infiltrate. The patient promptly responded to reduction of immunosuppressive therapy and antifungal treatment with amphotericin B lipid complex and flucytosine followed by maintenance treatment with fluconazole...Continue Reading

Citations

Aug 20, 2014·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Chinmaya Kumar BalShiv Kumar Sarin
Dec 7, 2007·Infectious Disease Clinics of North America·Emilio BouzaPatricia Muñoz
Jun 23, 2015·Current Opinion in Infectious Diseases·Andrés F Henao-Martínez, John David Beckham
Feb 10, 2020·Abdominal Radiology·Sodai HoshiaiManabu Minami

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