Posaconazole as successful treatment for fungemia due to Cryptococcus albidus in a liver transplant recipient

Abstract

A 55-year-old man with Laennec cirrhosis and a MELD score of 24 underwent orthotopic liver transplantation. Post-operatively his recovery was complicated by development of sepsis syndrome with fever and respiratory failure. Antimicrobial coverage with broad-spectrum antibacterials, fluconazole 400 mg IV daily, and prophylactic doses of oral trimethoprim/sulfamethoxazole and valganciclovir as well as immunosuppressive treatment with sirolimus, mycophenolate mofetil and intermittent doses of lymphocyte immune globulin, anti-thymocyte, were begun in the perioperative period. Focus of infection was not identified despite an aggressive evaluation including unremarkable physical examination and computed tomograms of the chest, abdomen, and pelvis, negative cultures of bronchoalveolar lavage fluid, negative stool assay for Clostridium difficile toxin, and multiple negative cultures of blood and urine. Daily fevers in excess of …