Cryptococcal meningitis after liver transplantation.
We present our experience with 10 liver transplant recipients in whom cryptococcal meningitis developed after liver transplantation. Disease developed a median period of 3.5 months (range, 2-36 months) after transplantation and patients were diagnosed a median period of 9 days (range, 2-90 days) after initial symptoms. Headache, fever, and mental status changes were the most frequent clinical presentations, while meningismus was found in only 30% of patients. Cerebrospinal fluid analysis was diagnostic in all cases. All patients were treated with amphotericin B and flucytosine. Immunosuppression was either decreased or discontinued during therapy. Five patients died, four as a direct result of cryptococcal infection and one as a result of chronic rejection. Three patients had long-term survival without any sequelae. One long-term survivor suffered blindness consequent to the disease. We conclude that cryptococcal meningitis is a rare complication in liver transplant recipients (0.25%), and has a high mortality rate (50%). Early recognition, combination antifungal therapy, and decrease or discontinuation of immunosuppression are important for cure. No relapse has been seen in surviving patients.
Jabbour
N
N
University of Pittsburgh, Pittsburgh Transplantation Institute, Pennsylvania 15213, USA.
Reyes
J
J
Kusne
S
S
Martin
M
M
Fung
J
J
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged
D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine