A Case Report of Antifungal-Resistant Cryptococcal Meningitis in a Patient with Kidney Transplant

Cryptococcal meningitis is a chronic fungal meningitis caused by Cryptococcus neoformans or Cryptococcus gattii. Acquired immunodeficiency syndrome (AIDS) and the use of immunosuppressive drugs are the main underlying factors of the disease. In this case report, we present a patient with cryptococcal meningitis who left the hospital after three months of unsuccessful monitoring and treatment.

The patient was a 20-year-old woman who underwent a kidney transplant three years before, and was referred to Alzahra hospital in Isfahan, Iran, with generalized headache, diplopia, photophobia, phonophobia, weight loss, vomiting, and Kernig's sign. By isolating the yeast from the cerebrospinal fluid, fluconazole was prescribed for her. After 18 days, the antifungal drug regimen was changed to amphotericin B deoxycholate. Due to no improvement in symptoms, the patient left the hospital after three months with personal consent. Molecular identification of the fungus was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. For this purpose, ITS1-5.8S-ITS2 region was amplified and cut with HpaII restriction enzyme and Cryptococcus neoformans was identified as the causative agent of infection using the digested band pattern (127 and 428 bp).

Patients taking immunosuppressive drugs are at risk for invasive fungal infections. Due to the emergence of resistant clinical isolates to antifungal agents, evaluation of drug susceptibility of fungi in specialized laboratories in parallel with clinical treatment of patients is recommended to prevent mortality and impose side effects of antifungal drugs on these patients.