Orthostatic hypotension as the initial presentation of disseminated cryptococcosis in a kidney transplant recipient

Abstract

Background: Solid organ transplant recipients are immunocompromised and at risk for invasive viral, fungal, and bacterial pathogens. Cryptococcus neoformans is the third most common invasive fungal infection in transplant recipients, and the clinical presentation of Cryptococcus neoformans infection can vary widely. Cryptococcal disease can affect the brain, lungs, skin, or vasculature, and it is frequently disseminated. Meningitis typically presents with fever, headache, and altered mental status. Solid organ transplant recipients with cryptococcosis tend to have poorer outcomes than HIV patients with cryptococcosis.

Case presentation: In this case report, we describe the case of a 69 year-old man with a past medical history of a deceased donor kidney transplant who presented with severe orthostatic hypotension and was found to have disseminated cryptococcosis.

Conclusions: This case report emphasizes the importance of broadening the differential diagnosis in transplant recipients who present with non-specific chief concerns.

Availability of data and materials: No datasets were used in the preparing of this manuscript. All patient information comes from the electronic health record and authors personal care of this patient.

Keywords: Cryptococcus; Fungal disease; HAART, Highly active anti-retroviral therapy; IRIS, immune reconstitution inflammatory syndrome; Infectious disease; Orthostatic hypotension; TRANSNET, Transplant-Associated Infection Surveillance Network; Transplant recipient; Transplant, medicine.