Abstract: FR-PO779
Neuro-Ophthalmic Manifestation of Cryptococcus Meningitis in a Kidney Transplant Patient
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Carias Martinez, Karla G., Johns Hopkins University, Baltimore, Maryland, United States
- Murphy, Olwen Cait, Johns Hopkins University, Baltimore, Maryland, United States
- Kant, Sam, Johns Hopkins University, Baltimore, Maryland, United States
Introduction
Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients- cryptococcal meningitis is the main clinical presentation. Vision loss in cryptococcal meningitis can be due to papilledema or optic nerve sheath infiltration
Case Description
37-year-old female with atypical HUS (aHUS) on chronic ravulizumab,LRKT in 2019 and 3 prioe failed kidney transplants,maintained on tacrolimus and prednisone for immunosuppression regimen was admitted with progressive left vision loss consistent with optic neuritis. She was initially given pulse steroids followed with a taper with no improvement in symptoms. Subsequent work-up showed cryptococcus fungemia and meningitis with high fungal load on CSF. MRI orbit with contrast (Figure 1) showed marked perineural enhancement of the left optic nerve.
There was no history of recent travel or constitutional symptoms. Mycophenolate was held and prompt treatment was started with Amphotericin and flucytosine induction for 2 weeks and then transitioned to maintenance fluconazole.
Discussion
Based on the clinical presentation and orbit MRI results that showed marked perineural enhancement of the optic nerve (a surrogate of meningeal inflammation) and the temporal association with her diagnosis of cryptococcal meningitis, this was deemed to be the most likely etiology of her vision loss. This is an unusual and rare presentation of cryptococcal meningitis but has been described in the literature. With her long-term use of CNIs, tacrolimus induced optic neuropathy was considered. This rare side effect, however, usually affects both optic nerves and orbital MRI reveal optic disc or nerve inflammation in the form of contrast enhancement. The common clinical practice is to switch tacrolimus to another immunosuppressive agent but as her clinical presentation was not consistent with this and her immunosuppression regimen was not altered.