Chaya Ramachandraiah, Padmanabhan Srinivasan, Anandaswamy Venugopal, Moin Aumir
Department of Microbiology, Apollo BGS Hospitals, Mysore, Karnataka, India.
J Infect Dev Ctries. 2013 Jan 15;7(1):60-3. doi: 10.3855/jidc.2479.
Cellulitis is an unusual presentation of cryptococcal infection in renal allograft recipients. In such patients, disseminated cryptococcal infection can result in significant morbidity and mortality. Patients are often treated with antibiotics before a definitive diagnosis is made, delaying appropriate therapy. We describe the case of a 43-year-old post renal transplant recipient presenting with fever and swelling in the right thigh. On physical examination, the patient was found to have features suggestive of cellulitis with minimal slurring of speech. Material obtained from incision and drainage of the wound showed yeast cells resembling Cryptococcus spp. Blood culture and cerebrospinal fluid culture were also found to have growth of Cryptococcus neoformans. He received treatment with amphotericin B 6 mg/kg daily intravenously for two weeks, then continued with fluconazole 400 mg daily for three months. The patient showed a remarkable improvement. There was no recurrence of cryptococcosis after four months of follow-up. The diagnosis of disseminated cryptococcosis should be considered in differential diagnosis of cellulitis among non HIV immunocompromised hosts. A high clinical suspicion and early initiation of therapy is needed to recognize and treat patients effectively.
蜂窝织炎是肾移植受者中隐球菌感染的一种不常见表现。在此类患者中，播散性隐球菌感染可导致显著的发病率和死亡率。在做出明确诊断之前，患者常接受抗生素治疗，从而延误了适当的治疗。我们描述了一例43岁的肾移植术后受者，其表现为右大腿发热和肿胀。体格检查发现患者有蜂窝织炎的特征，伴有轻微言语不清。从伤口切开引流获取的材料显示出类似隐球菌属的酵母细胞。血液培养和脑脊液培养也发现有新生隐球菌生长。他接受了为期两周的每日静脉注射6mg/kg两性霉素B的治疗，然后继续每日服用400mg氟康唑，持续三个月。患者病情显著改善。随访四个月后，隐球菌病未复发。在非HIV免疫功能低下宿主的蜂窝织炎鉴别诊断中，应考虑播散性隐球菌病的诊断。需要高度的临床怀疑和早期开始治疗，以有效识别和治疗患者。
