A rare case of Cryptococcus gattii pneumonia in a renal transplant patient

Abstract

Cryptococcus neoformans and Cryptococcus gattii are environmental fungi that can cause fever, cough, pneumonia, meningoencephalitis, dissemination, and death. C. gattii causes cryptococcomas more frequently than does C. neoformans and may require prolonged antifungal treatment. We present a rare case of C. gattii pneumonia in a renal transplant patient. A 44-year-old man, living in a rural area endemic for C. gattii and who had received a kidney transplant, was admitted to the hospital with fever, vomiting, weight loss, and diarrhea. A chest computed tomography revealed 2 alveolar, nodular, subpleural infiltrates in the periphery of the lungs. Differential diagnoses included infectious infiltrates, granulomatosis, embolization, and hemorrhage. C. gattii, molecular type VGI, was confirmed on day 28. Treatment consisted of amphotericin B at 1 mg/kg/day or fluconazole at 800 mg/day for first 6 weeks, followed by fluconazole at 400 mg/day for the subsequent 12 months. Response to the therapy has been slow. Because of the occurrence of outbreaks and its high morbidity and mortality rates, physicians must be aware of this complication in transplant recipients to avoid delays in diagnosis and to provide prompt management.

Ecoepidemiology of Cryptococcus gattii in Developing Countries

“…C. gattii sensu stricto (s.s.) (genotype AFLP4/VGI) is a major aetiologic agent of cryptococcosis among immunocompetent patients from Brazil [ 25 , 26 , 27 ], Colombia [ 29 ], Mexico [ 33 , 34 ], Honduras [ 32 ], and Peru [ 35 ] and has caused pneumonia in a renal transplant patient from Argentina [ 21 ]. This pathogen has also been involved with a fatal infection in Cuba in an imported cheetah from South Africa [ 31 ].…”

The status of cryptococcosis in Latin America

“… Molecular data have been combined from studies reported in Argentina ( Meyer et al. 2003 , Refojo et al 2009 , Cattana et al 2013 , Mazza et al 2013 , Cattana et al 2014 , Cattana et al 2015 , Cicora et al 2015 , Arechavala et al 2017 ), Brazil ( Casali et al 2003 , Trilles et al 2003 , Igreja et al 2004 , Abegg et al 2006 , Ribeiro et al 2006 , Matsumoto et al 2007 , Lugarini et al 2008 , Ribeiro & Ngamskulrungroj 2008 , dos Santos et al 2008 , Trilles et al 2008 , Costa et al 2009 , Andrade-Silva et al 2010 , Pinto Jr et al 2010 , Souza et al 2010 , Ferreira-Paim et al 2011, d , da Silva et al 2012 , Freire et al 2012 , Silva et al 2012 , Cardoso et al 2013 , Tsujisaki et al 2013 , Anzai et al 2014 , Nascimento et al 2014 , Brito-Santos et al 2015 , Headley et al 2015 , Castro e Silva et al 2016 , Figueiredo et al 2016 , Lomes et al 2016 , Souto et al 2016 , Aguiar et al 2017, d , da Silva et al 2017) , Chile ( Calvo et al 2001 , Meyer et al. 2003 , Solar et al 2015) , Colombia ( Meyer et al 2003 , Escandón et al 2006 , Escandón et al 2010 , Firacative et al 2011 , Lizarazo et al 2012 , Lizarazo et al 2014a , Lizarazo et al 2014b , Noguera et al 2015 , Cogliati et al ...…”

“…Case reports, in which C. gattii has been isolated as etiological agent, have been documented much more recently ( Illnait-Zaragozi et al 2013 , Nascimento et al. 2014 , Cicora et al 2015 , Solar et al 2015 , Noguera et al 2017 ), with the earliest occurring in 2005 in Brazil ( Pinto Jr et al 2010 ). The major molecular type of the environmental isolates was first reported about two decades ago in Cuba ( Illnait-Zaragozi et al 2010a ), although most of the reports on the molecular types of C. neoformans and C. gattii from the environment are from after the year 2000.…”

Colliding Epidemics and the Rise of Cryptococcosis

“…Of 52 SOT recipients with cryptococcosis described by Davis in 2009, organs transplanted included kidney (51.9%), liver (23.1%), lung (11.5%), heart (7.7.%), kidney–liver (1.9%), heart–lung (1.9%) and liver–pancreas–small bowel (1.9%) [ 28 ]. More recent reports of cryptococcosis post-SOT include those post-renal transplants [ 31 , 32 , 33 ], liver transplant [ 34 ], post-heart transplant [ 35 ], post-lung transplant [ 35 , 36 ] and a rare case of cryptococcosis post-autologous stem cell transplant [ 37 ]. While the majority present with CM, pulmonary infection and cutaneous cryptococcosis have also been reported [ 38 , 39 ].…”