Recurrent Fatal Cryptococcal Meningitis in a Patient with Liver Transplant: A Case Report and Review of Literature

Abstract

Introduction: Cryptococcal meningitis is a significant leading cause of death among individuals with HIV worldwide. It is caused by Cryptococcus neoformans and the C. gattii species complex. The primary predisposing factor is HIV, but it can also be observed in conditions such as immunodeficiency, sarcoidosis, liver disease, solid organ transplantation, and steroid treatment. Case Presentation: This report discusses a 61-year-old man with a medical history of liver transplantation, open-heart surgery, diabetes, hypertension, and previous cryptococcal meningitis. He had been receiving antifungals and was discharged in good condition to continue maintenance treatment at home. During his latest admission, he was hospitalized to investigate weakness and suspicious ulcerated skin lesions refractory to glucantime through biopsy. Two days after hospitalization and before receiving the biopsy result, the patient gradually developed lethargy, headache, and nausea. Laboratory examinations of cerebrospinal fluid (CSF) and skin biopsies revealed encapsulated yeast cells identified as C. neoformans using culture media and the PCR method. The patient died shortly after receiving liposomal amphotericin B and oral fluconazole. Conclusions: This case emphasizes the importance of follow-up visits for high-risk patients, early screening for fungal infections, and long-term antifungal treatment, especially in immunocompromised patients, to reduce unfavorable outcomes.