Transmission of cryptococcosis by liver transplantation:A case report and review of literature

• 作者: Andre Luis Conde Watanabe Carolina de Fatima Couto Fernando Marcus Felippe Jorge Gabriel Oliveira Nunes Caja Gustavo de Sousa Arantes Ferreira Natalia de Carvalho Trevizoli Priscila Brizolla de Campos
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: CRYPTOCOCCOSIS Liver transplantation Cryptococcus neoformans Case report IMMUNOSUPPRESSION Fungal infection
• 年，卷（期）: 2020,（5）
• 页码范围: 253-261
• 页数: 9页
• 分类号: R73

摘要

BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(C.neoformans)species complex.These fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency virus.The fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been reported.CASE SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the procedure.The patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few days.Blood cultures were positive for C.neoformans.Liver biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous formations.Magnetic resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical regions.Treatment with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the symptoms.The recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of infection.The organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ procurement.CONCLUSION This case highlights the risk of transmission of fungal diseases,specifically of C.neoformans,through liver graft during liver transplantation.