title: Donor-derived Cryptococcus infection in liver transplant: case report and literature review.
abstract: Cryptococcosis occurring within 30 days after transplant is unusual. We present a case of cryptococcosis diagnosed within 2 weeks of liver transplant and cryptococcal infection transmitted by liver transplant is considered as the cause. A 63-year-old woman with hepatitis C virus-related cirrhosis and hepatocellular carcinoma had an orthotopic liver transplant from a 45-year-old donor. The immediate postoperative course was smooth, although she was confused with a fever, tachycardia, respiratory failure of 1 week's duration after the orthotopic liver transplant. A liver biopsy was performed for hyperbilirubinemia 2 weeks after the orthotopic liver transplant that showed a Cryptococcus-like yeast. Her blood culture was reexamined, and it was confirmed as Cryptococcus neoformans that had been misinterpreted as candida initially. At the time of the re-examination, her sputum was clear. We checked her preoperative blood sample, retrospectively, for serum cryptococcal antigen with negative result. She was on liposomal amphotericin treatment for 1 month when her blood culture became negative. She was discharged home, with good liver function and a low antigen titer for cryptococcal infection. Cryptococcal disease usually develops at a mean of 5.6 months after transplant. However an early occurrence is rare. Apart from that, its variable clinical presentations make early detection difficult. It might be an early reactivation or a donor-derived infection. The latter usually occurs in unusual sites (eg, the transplanted organ as the sole site of involvement). Our case presented as cryptococcoma and liver involvement was diagnosed by an unintentional liver biopsy.
authors.affiliation: Department of General Surgery Dalin Tzu Chi General Hospital Surgery, Chia-I, Taiwan.
authors.forename: Chun-Min
authors.initials: CM
authors.lastname: Chang
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
authors.forename: Chih-En
authors.initials: CE
authors.lastname: Tseng
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tseng
authors.forename: Kuo-Chih
authors.initials: KC
authors.lastname: Tseng
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Lin
authors.forename: Chang-Kuo
authors.initials: CK
authors.lastname: Wei
authors.forename: Wen-Yao
authors.initials: WY
authors.lastname: Yin
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission*; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000382:microbiology; D008099:Liver / Q000382:microbiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B