Sevgin Taner,Ipek Kaplan  Bulut,Betul  Ekici,Cemaliye  Basaran,Furkan  Polat,Caner  Kabasakal,
Cryptococcal Pneumonia in a Pediatric Patient with Renal Transplantation
Transplantation Case Reports
2020
2733-2527
http://dx.doi.org/10.31487/j.TCR.2020.01.08
https://www.sciencerepository.org/cryptococcal-pneumonia-in-a-pediatric-patient-with-renal-transplantation_TCR-2020-1-108 
Abstract: Cryptococcosis is a significant opportunistic infection in solid organ transplant recipients. Patients may have
asymptomatic colonization or symptoms of isolated pulmonary disease and severe pneumonia. The disease
is diagnosed by culture, direct microscopy or detection of cryptococcal antigen in the body fluid or tissues.
We herein present a C. neoformans pneumonia in a renal transplant patient. An 18-year-old male, renal
transplanted from his mother, admitted to hospital due to increase in creatinine. On physical examination,
there was no finding other than hypertension and operation scar. Urea and creatinine were increased. Renal
doppler USG revealed increased renal parenchymal echogenicity. Immunosuppressive drug levels were in
normal range. Renal biopsy was consistent with acute cellular rejection and treatment was started. Fever
appeared on the following week. Immunosuppressants doses were reduced; antibiotics started empirically.
HRCT revealed multiple nodules, lymphadenopathies and pleural effusion. C. neoformans was detected in
blood culture. Detailed history revealed the patient was pigeon feeder. 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 and followed by prophylaxis.
The patient is now being followed up at baseline creatinine 1.73 mg / dl in the 1st year after discharge. We
would like to remind that opportunistic fungal infections may also be the cause of fever in solid organ
transplant patients. It should be noted these infections may result with high mortality without early diagnosis
and appropriate treatment.Keywords: Cryptococcosis, Cryptococcus neoformans, C. neoformans, opportunistic infections