Disseminated cryptococcosis in a child with liver transplantation: a case report

Background. Cryptococcus neoformans causes cryptococcosis, primarily affecting immunocompromised individuals, including solid-organ transplant recipients, and, less frequently, immunocompetent people. Case. A 15-year-old male with congenital hepatic fibrosis, portal hypertension, and cirrhosis under...

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Vydané v:	The Turkish journal of pediatrics Ročník 66; číslo 4; s. 499 - 504
Hlavní autori:	Barut, Doğan, Kunay, Bora, Yıldırım Arslan, Sema, Akkuş, Gözde Kayalı, Şahbudak Bal, Zümrüt, Yazıcı, Pınar, Karakoyun, Miray, Aydoğdu, Sema
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Turkey Akdema Informatics and Publishing 07.10.2024 Hacettepe University Faculty of Medicine Hacettepe University Institute of Child Health
Predmet:	Adolescent Anti-Infective Agents - therapeutic use Antifungal agents Antifungal Agents - therapeutic use Blood Congenital diseases Consent Cryptococcal infections cryptococcosis Cryptococcosis - complications Cryptococcosis - drug therapy Cryptococcus neoformans Development and progression Disease prevention Fatal Outcome Fluconazole Fluconazole - therapeutic use Fungal infections Gastrointestinal Hemorrhage - microbiology Hemoglobin Humans Hypertension Hypertension, Portal - congenital Hypertension, Portal - microbiology Hypertension, Portal - surgery Hypoxia Hypoxia - microbiology Immunocompetence Immunocompromised Host immunocompromised patients Ischemia Kidney transplants Laboratories Leukocytes Liver Liver cirrhosis Liver Cirrhosis - congenital Liver Cirrhosis - microbiology Liver Cirrhosis - surgery liver transplantation Liver Transplantation - adverse effects Liver transplants Lymphadenitis - microbiology Magnetic resonance imaging Male Medical examination Meningitis Meningitis, Fungal - microbiology Mortality Organ transplant recipients Pancreatitis Pancreatitis - microbiology Patients Pediatrics Perioperative Care Pneumonia Pneumonia - microbiology Polymerase chain reaction Postoperative Complications - microbiology Postoperative Complications - prevention & control Respiratory failure Tazobactam Transplantation Viruses Yeast immunocompromised patients cryptococcosis liver transplantation
ISSN:	0041-4301, 2791-6421, 2791-6421
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Shrnutí:	Background. Cryptococcus neoformans causes cryptococcosis, primarily affecting immunocompromised individuals, including solid-organ transplant recipients, and, less frequently, immunocompetent people. Case. A 15-year-old male with congenital hepatic fibrosis, portal hypertension, and cirrhosis underwent orthotopic liver transplantation. He received perioperative antimicrobial and antifungal prophylaxis and continued immunosuppressive treatment. Thirty months post-transplant, he presented with fever, hypertension, and sacroiliac joint pain. Peripheral blood cultures showed C. neoformans, confirmed by pan-fungal polymerase chain reaction assay and latex agglutination tests. Despite initial treatment with intravenous (IV) fluconazole, his condition worsened, necessitating intubation for acute hypoxic respiratory failure. Magnetic resonance imaging and computed tomography scans indicated disseminated cryptococcosis with lymphadenitis, possible meningitis, and pneumonia. Treatment was escalated to IV liposomal amphotericin B and 5-flucytosine, while reducing immunosuppressive treatment. Despite negative fungal cultures on the tenth day, the patient deteriorated, developing pancreatitis, pneumonia, and massive gastrointestinal bleeding, leading to death on the 35th day of hospitalization. Conclusion. This case shows the severity and complexity of managing disseminated cryptococcosis in pediatric liver transplant recipients. Aggressive therapy and early identification are essential for improving outcomes in these high-risk patients.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Case Study-2 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0041-4301 2791-6421 2791-6421
DOI:	10.24953/turkjpediatr.2024.4817