EC Clinical and Medical Case Reports

Cryptococcosis is an opportunistic fungal infection primarily caused by Cryptococcus neoformans and C. gattii, which poses significant risks for immunocompromised individuals, particularly kidney transplant recipients. This case report describes a 55-year-old female patient with a history of end-stage renal disease who underwent living donor kidney transplantation seven years prior. She presented with severe headache, fever, and altered mental status indicative of cryptococcal meningitis. Initial diagnostic evaluations included imaging studies that returned normal results, while cerebrospinal fluid analysis revealed elevated opening pressure, lymphocytic pleocytosis, and positive CrAg testing for C. neoformans. Notably, the patient exhibited a false-negative serum CrAg result attributed to the postzone phenomenon, emphasizing the need for careful interpretation of diagnostic tests in immunocompromised patients. Treatment involved induction therapy with liposomal amphotericin B and flucytosine, followed by fluconazole maintenance therapy. This case highlights the complexities of diagnosing and managing cryptococcal infections in kidney transplant recipients, underscoring the importance of early recognition, tailored treatment strategies, and the potential need for dilutional testing in cases of suspected cryptococcal disease.

 Keywords: Cryptococcal Meningitis; Kidney Transplant Recipient; Cryptococcosis

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