Disseminated Cryptococcosis in a Lung Transplant Recipient: Diagnostic and Therapeutic Challenges

Abstract

Cryptococcosis represents the third most frequent invasive fungal infection in solid organ transplant (SOT) recipients and is associated with high mortality rates. Its clinical presentation is often insidious making the diagnosis difficult. Treatment guidelines are mainly derived from the population affected by human immunodeficiency virus (HIV) and trials specific to the SOT population are lacking. Here, we present the case of a 67-year-old lung transplant recipient with acute-on-chronic kidney failure and disseminated cryptococcosis successfully treated with a regimen of two single high doses of intravenous (IV) liposomal amphotericin B (10 mg/kg) on day 1 and day 7 in association with IV flucytosine and high doses of oral fluconazole, hence limiting the nephrotoxicity of amphotericin B. Treatment approaches for cryptococcosis in SOT limiting the nephrotoxicity of amphotericin B need to be further studied. PEER REVIEWED ARTICLE Peer reviewers: Two anonymous peer reviewers. Received: November 21, 2023; Accepted after peer review: January 9, 2024