Division of Gastroenterology, Hepatology and Nutrition Disease, Department of Pediatrics, Medical School of Ege University, İzmir, Türkiye.
Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, İzmir, Türkiye.
Turk J Pediatr. 2024 Oct 7;66(4):499-504. doi: 10.24953/turkjpediatr.2024.4817.
Cryptococcus neoformans causes cryptococcosis, primarily affecting immunocompromised individuals, including solid-organ transplant recipients, and, less frequently, immunocompetent people.
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.
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.
新型隐球菌引起隐球菌病，主要影响免疫功能低下的个体，包括实体器官移植受者，以及免疫功能正常的人群，但较少见。
一名 15 岁男性患有先天性肝纤维化、门静脉高压和肝硬化，接受了原位肝移植。他接受了围手术期抗菌和抗真菌预防，并继续接受免疫抑制治疗。移植后 30 个月，他出现发热、高血压和骶髂关节疼痛。外周血培养显示新型隐球菌，经全真菌聚合酶链反应检测和乳胶凝集试验证实。尽管最初接受了静脉注射（IV）氟康唑治疗，但他的病情恶化，需要插管治疗急性低氧性呼吸衰竭。磁共振成像和计算机断层扫描显示播散性隐球菌病伴淋巴结炎、可能的脑膜炎和肺炎。治疗升级为 IV 两性霉素 B 脂质体和 5-氟胞嘧啶，同时减少免疫抑制治疗。尽管在第十天真菌培养阴性，但患者病情恶化，出现胰腺炎、肺炎和大量胃肠道出血，最终在住院第 35 天死亡。
本例表明，管理儿童肝移植受者播散性隐球菌病的严重性和复杂性。对于这些高危患者，积极治疗和早期识别对于改善预后至关重要。
