Cryptococcoma of a transplanted kidney in a patient presenting with recurrent urinary tract infection : a case report

Show simple item record Muranda, A.Z. (Albert) Greeff, Ludolf Sathekge, Mike Machaba Lengana, Thabo Karusseit, V.O.L. (Otto) 2018-10-03T12:56:19Z 2018-10-03T12:56:19Z 2018-04-23
dc.description.abstract BACKGROUND : Cryptococcosis is an important opportunistic infection of organ transplant recipients. It is the third most common fungal infection of transplant patients and occurs especially in kidney recipients. Cryptococcus neoformans is a ubiquitous fungus which infects humans by inhalation of spores. C. gattii has more recently been recognised as a pathogen. Infection commonly is disseminated affecting mainly the central nervous system and the lungs. Cryptococcoma, a localised form of the disease, has been described in various organs. We present a unique case of a cryptococcoma in a transplanted kidney. The lesion was not seen on ultrasound or uncontrasted computerised tomography but was detected by FDG-PET/CT. CASE PRESENTATION : A 30 year old woman received a deceased donor kidney transplant in 2005. Due to chronic allograft nephropathy in 2014, cyclosporine and azathioprine immunosuppression was changed to tacrolimus and mycophenolate. After rapid deterioration of renal function in 2015 due to suspected non-adherence to immunosuppressants, steroid pulses were administered. The patient developed severe recurrent bacterial urinary tract infections and demonstrated several features of severe immunosuppression. She was treated for cytomegalovirus infection and BK virus was demonstrated in the urine. In addition, Kaposi sarcoma of the stomach was diagnosed on endoscopic biopsy. A metabolically-active lesion of the kidney transplant was imaged on FDG-PET/CT scan. Biopsy of the lesion demonstrated infection with cryptococcus. Escherichia coli with the same antibiotic sensitivity spectrum as that in the urine was cultured from the biopsy. Cryptococcus was not cultured from urine at that time or from several subsequent specimens. The lesion was not detected by conventional imaging. The patient manifested no other evidence of cryptococcosis. The lesion responded poorly to treatment with fluconazole. CONCLUSIONS : This is probably the first report of a case of a cryptococcoma in a transplanted organ. FDG-PET/CT scan, which is dependent on cellular metabolism, proved useful in visualising the lesion. Clinicians should be aware of this rare presentation of cryptococcosis in organ transplant recipients en_ZA
dc.description.department Nuclear Medicine en_ZA
dc.description.department Surgery en_ZA
dc.description.librarian am2018 en_ZA
dc.description.uri en_ZA
dc.identifier.citation Muranda, A.Z., Greeff, L., Sathekge, M.M. et al. 2018, 'Cryptococcoma of a transplanted kidney in a patient presenting with recurrent urinary tract infection : a case report', BMC Nephrology, vol. 17, art. 94, pp. 1-5. en_ZA
dc.identifier.issn 1471-2369 (online)
dc.identifier.other 10.1186/s12882-018-0891-8
dc.language.iso en en_ZA
dc.publisher BioMed Central en_ZA
dc.rights © The Author(s). 2018 Open Access . This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. en_ZA
dc.subject Cryptococcosis en_ZA
dc.subject Cryptococcoma en_ZA
dc.subject FDG-PET/CT scan en_ZA
dc.subject Kidney transplant en_ZA
dc.subject Urinary tract infection (UTI) en_ZA
dc.subject Case report en_ZA
dc.subject Impacts en_ZA
dc.subject Cancer en_ZA
dc.subject Neoformans en_ZA
dc.subject Recipients en_ZA
dc.subject Invasive fungal infections en_ZA
dc.title Cryptococcoma of a transplanted kidney in a patient presenting with recurrent urinary tract infection : a case report en_ZA
dc.type Article en_ZA

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