Abstract: SA-PO1162
Cryptococcal Meningitis in a Kidney Transplant Recipient Presenting with Subacute Neurological Decline
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Sookram, Videsh J., East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Ratcliffe, Laura Ema Kvetuse, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
Introduction
Cryptococcal meningitis is a life-threatening opportunistic infection that primarily affects immunocompromised individuals, including solid organ transplant recipients. Clinical presentation is often subacute and non-specific, leading to potential delays in diagnosis.
Case Description
A renal transplant recipient transplanted in 2023 and maintained on tacrolimus and prednisolone presented with a one-month history of progressive neurological decline, including intermittent confusion, tremor, poor balance and headaches. Collateral history revealed fluctuating cognition and worsening balance, particularly during episodes of hyponatraemia. Past medical history included type 2 diabetes mellitus, giant cell arteritis and previously treated spermatic cord tuberculosis.
Neurological examination demonstrated confusion, hypertonia and a left-sided intention tremor without focal deficits. Inflammatory markers remained normal and graft function was stable throughout admission. CT and MRI brain imaging were unremarkable.
Lumbar puncture demonstrated CSF pleocytosis and elevated protein, with Cryptococcus species isolated from CSF confirming cryptococcal meningitis. Further infectious investigations including neuroviral PCR and tuberculosis testing were negative.
Empirical ceftriaxone was commenced initially, followed by liposomal amphotericin B after diagnosis. Due to delayed availability of flucytosine, induction therapy initially consisted of amphotericin B and fluconazole before transition to standard therapy. Tacrolimus levels required close monitoring because of azole interaction. The patient remained haemodynamically stable with preserved graft function and was transferred to a tertiary Infectious Diseases centre for ongoing management.
Discussion
Cryptococcal meningitis is an important opportunistic infection in renal transplant recipients. This case highlights the diagnostic challenge of subacute neurological decline despite normal inflammatory markers and unremarkable neuroimaging. Definitive diagnosis relied on CSF analysis, despite a normal opening pressure. Early lumbar puncture should therefore be considered in immunocompromised patients presenting with unexplained neurological symptoms. MDT management and careful immunosuppression adjustment were essential to preserve graft function.