SHM Converge Scientific Abstract ePoster Gallery-The Fever That Wouldn't Break: A Transplant Recipient's Cryptic Diagnosis

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This case highlights cryptococcosis as an important and often subtle opportunistic infection in solid-organ transplant recipients. A 68-year-old man, three months after liver transplant and taking tacrolimus, mycophenolate, and prednisone, presented with several days of fever, fatigue, weakness, chills, and mild confusion. He had no headache, neck stiffness, respiratory symptoms, or other clear infectious source. Initial evaluation, including chest radiograph, head CT, urinalysis, liver tests, and tacrolimus level, was unrevealing, and broad-spectrum antibiotics did not improve his persistent fevers.<br /><br />As the workup expanded, CT imaging showed scattered pulmonary nodules. Fungal testing for Histoplasma and Coccidioides was negative, but serum cryptococcal antigen was strongly positive. Subsequent fungal blood cultures grew Cryptococcus neoformans. Because he reported mild confusion despite lacking classic meningeal signs, lumbar puncture was performed and confirmed CNS involvement: CSF showed lymphocytic pleocytosis, elevated protein, mildly increased opening pressure, and a high cryptococcal antigen titer, consistent with cryptococcal meningitis.<br /><br />He was treated with induction antifungal therapy using amphotericin B and flucytosine, then transitioned to fluconazole for consolidation. His fever and cognitive symptoms improved.<br /><br />The report emphasizes that cryptococcosis in transplant patients often presents subacutely with nonspecific symptoms such as fever, fatigue, pulmonary nodules, or subtle mental status changes, and may lack typical signs of meningitis. Because delayed diagnosis worsens outcomes, clinicians should maintain a high index of suspicion, use serum cryptococcal antigen testing early, and perform lumbar puncture promptly when CNS disease is possible.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ali Farkhondehpour, Karena P. Nguyen

Category Clinical Vignettes

Concept Cryptococcosis

Concept Cryptococcal Meningitis

Concept Solid Organ Transplant Recipient

Concept Serum Cryptococcal Antigen Test

Concept Lumbar Puncture

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

cryptococcosis

solid-organ transplant

liver transplant

Cryptococcus neoformans

cryptococcal meningitis

serum cryptococcal antigen

immunosuppression

pulmonary nodules

lumbar puncture

amphotericin B flucytosine

Cryptococcosis

Cryptococcal Meningitis

Solid Organ Transplant Recipient

Serum Cryptococcal Antigen Test

Lumbar Puncture