The Brief Case: the Cryptic Cryptococcus.

Abstract

A 64-year-old male with a history of nonalcoholic steatohepatitis, alpha-1-antitrypsin deficiency, and an orthotopic liver transplant completed 5 months prior, presented to the hospital with a 1-day history of fever and fatigue. The patient had recently undergone evaluation for rash and pancytopenia and was ultimately diagnosed with graft-versus-host disease (GVHD) affecting his skin, gastrointestinal tract, and bone marrow. High-dose prednisone and twice-weekly etanercept were added to his prior immunosuppressant regimen of tacrolimus and mycophenolate. During a subsequent outpatient evaluation for bone marrow transplantation, he developed fever and fatigue again and was admitted to the hospital for further evaluation.