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Case report
Parkinsonism and prolonged cognitive decline as a manifestation of cryptococcal meningitis in a renal transplant patient
  1. Ricky Nelles1,
  2. Sumudu Britton2,3,
  3. George Tharayil John3,4 and
  4. Charles Denaro3,5
  1. 1Haematology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
  2. 2Infectious Disease Unit, Royal Brisbane Hospital, Herston, Queensland, Australia
  3. 3Faculty of Medicine, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
  4. 4Renal Unit, Royal Brisbane Hospital, Herston, Queensland, Australia
  5. 5Department of Internal Medicine & Aged Care, Royal Brisbane Hospital, Herston, Queensland, Australia
  1. Correspondence to Dr Ricky Nelles; ricky.nelles{at}health.qld.gov.au

Abstract

We report a case of a 67-year-old male recipient of a second renal allograft, presenting with a 9-month history of progressive cognitive and physical decline with features of Parkinsonism. He was HIV-negative. Serum and cerebrospinal fluid (CSF) cryptococcal antigen was positive though CSF culture was sterile. He had progressive deterioration despite induction and consolidation antifungal treatment. Postmortem brain examination confirmed a large burden of yeast forms in the substantia nigra with widespread chronic meningitis. The significant delay in presentation and diagnosis owing to the atypical, subacute neurocognitive features serves as a timely reminder of the variety of neurological presentations that may be associated with cryptococcal infection in solid organ transplant recipients.

  • cryptococcosis
  • meningitis
  • infection (neurology)
  • renal transplantation

https://doi.org/10.1136/bcr-2021-245788

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    Footnotes

    • Contributors RN drafted the manuscript. SB, GTJ and CD provided detailed editorial feedback and made significant changes to the draft manuscript before submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.