A Retrospective Analysis of Pulmonary Cryptococcosis Following Kidney Transplantation: Clinical Presentation, Treatment and Effectiveness
Abstract Background: The use of immunosuppressors and a relatively weaken cell-mediated immunity make organ transplant recipients particularly vulnerable to cryptococcosis infection. Patients infected usually present only nonspecific symptoms, making it extremely possible for misdiagnosis and inappropriate choice of therapeutic approach. Methods: We compiled and analysed data of patients received kidney transplant in our hospital between April 2006 to January 2021. Results: 18 patients were enrolled into the study, ranging between 27-68 years old. The median time from kidney transplantation to pathologically-confirmed infection was 4.09 years. All patient’s respiratory system was affected, showing symptoms including sputum-producing cough and fever. 3 patients (16.67%) also developed central nervous system (CNS) infections. Nodule-shaped infectious sites were frequently observed (10, 58.82%) in chest CT. Blood works showed no specific changes. 7 patients received thoracoscopic lobectomy in suspicion of lung cancer. 3 patients first received antifungal therapy for a period of time and then underwent thoracoscopic lobectomy. No recurrence whatsoever was observed in all 10 surgically-intervened patients. 8 patients received only antifungal therapy, 7 of them showed a substantial reduction in the size of the infectious site. Fluconazole was most frequently prescribed for antifungal therapy. Conclusion: Most patients developed pulmonary cryptococcosis 2 years after transplantation. Patients usually demonstrate symptoms like fever and sputum-producing cough. The possibility of cryptococcal meningitis shouldn’t be ruled out if corresponding symptoms occur. CT presentation may be confused with lung cancer. Fluconazole is commonly prescribed for treatment and can usually yield satisfied outcome. In patients received unsatisfactory antifungal therapy, surgical therapy should be considered a possibility.