CRYPTOCOCCOSIS AFTER RENAL-TRANSPLANTATION - REPORT OF 10 CASES

Abstract

Ten cases of cryptococcosis were identified in a 13 yr experience with > 650 renal transplants. Eight patients had meningitis, 1 patient had a cerebral granuloma, and in 1 patient the infection appeared to be limited to the lungs. The CNS infection often masqueraded as a brain tumor and was not suspected initially. The most useful diagnostic test was cerebrospinal fluid examination including India ink preparation. Various therapeutic regimens with amphotericin B and 5-fluorocytosine were effective in suppressing the infection. A combination of low doses of amphotericin B, not affecting kidney function, and 5-fluorocytosine for at least 3 mo. was associated with remission of disease in 5 patients who still are alive, including 3 patients without recurrence for longer than 1 yr. Five deaths 3 wk-4 yr after the beginning of treatment were not due to cryptococcosis; death resulted from vascular disease and septicemia in 3 of the 4 patients with known causes of death. CNS cryptococcosis, with the exception of the rare cerebral granuloma, is associated with little inflammation. If early death from increased intracranial pressure or cerebral edema is prevented, prolonged therapy with amphotericin B and 5-fluorocytosine may be expected to control the infection, even in immunosuppressed patients.