SHM Converge Scientific Abstract ePoster Gallery-Cryptococcus Neoformans in an Immunocompromised Patient With Rapidly Progressing Glomerulonephritis

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This case describes a 73-year-old man with rapidly progressing glomerulonephritis (RPGN) and chronic kidney disease who was treated with high-dose prednisone and mycophenolate after renal biopsy showed membranoproliferative and necrotizing crescentic glomerulonephritis with IgM kappa deposition and predominant C3 deposits. His workup for malignancy and plasma cell dyscrasia was negative.<br /><br />One month after starting immunosuppressive therapy, he was hospitalized for an ST-elevation myocardial infarction and began dual antiplatelet therapy. During that admission, he developed septic shock due to Cryptococcus neoformans fungemia, with encephalopathy and acute hypoxemic respiratory failure requiring intubation and mechanical ventilation. A very high cryptococcal antigen titer (1:1280) suggested disseminated infection. Despite treatment, he died after transition to comfort measures.<br /><br />The report highlights that Cryptococcus neoformans is an opportunistic fungal pathogen typically seen in immunocompromised patients, including those with HIV, transplant recipients, and patients receiving prolonged corticosteroids. Because this patient was already receiving prophylaxis against Pneumocystis jirovecii with atovaquone, the authors raise the question of whether antifungal prophylaxis, such as fluconazole, should also be considered in certain patients receiving prolonged high-dose steroids or other intensive immunosuppression.<br /><br />The authors conclude that early recognition and treatment of RPGN are important for preserving kidney function, but immunosuppressive therapy can increase the risk of severe opportunistic infections. They suggest that more research is needed to determine whether prophylaxis against invasive fungal infections could benefit this patient population.

Asset Subtitle

Alejandra Perez-Chapman

Meta Tag

Author List Alejandra Perez-Chapman, Deepa Kumarjiguda, Monica Dzwonkowski, Prasanthi Limgala, Sanjeev Shrestha

Category Clinical Vignettes

Concept Rapidly Progressive Glomerulonephritis

Concept Immunosuppressive Therapy

Concept Cryptococcus neoformans

Concept Disseminated Cryptococcosis

Concept Opportunistic Infection

Distinguished Non-Finalist

Presenter Organization Geisinger Medical Center

Presenting Author Alejandra Perez-Chapman

Track Adult

Keywords

rapidly progressive glomerulonephritis

membranoproliferative glomerulonephritis

necrotizing crescentic glomerulonephritis

Cryptococcus neoformans

opportunistic fungal infection

immunosuppressive therapy

high-dose prednisone

mycophenolate

cryptococcal fungemia

antifungal prophylaxis

Rapidly Progressive Glomerulonephritis

Immunosuppressive Therapy

Cryptococcus neoformans

Disseminated Cryptococcosis

Opportunistic Infection