Parkinsonism and prolonged cognitive decline as a manifestation of cryptococcal meningitis in a renal transplant patient

• Published in: BMJ case reports Vol. 15; no. 1; p. e245788
• Main Authors: Nelles, Ricky, Britton, Sumudu, John, George Tharayil, Denaro, Charles
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 19.01.2022; BMJ Publishing Group
• Subjects: Aged; Alzheimer's disease; Antifungal agents; Antigens; Brain diseases; Case Report; Case reports; Cognition & reasoning; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Cryptococcosis; Cryptococcus neoformans; Dementia; Diagnostic tests; Encephalitis; Enteral nutrition; Fluconazole; HIV; Human immunodeficiency virus; Humans; Infections; Kidney Transplantation - adverse effects; Kidney transplants; Male; Meningitis; Meningitis, Cryptococcal - diagnosis; Meningitis, Cryptococcal - drug therapy; Parkinson's disease; Parkinsonian Disorders - etiology; Patients; Proteins; India; infection (neurology); renal transplantation; cryptococcosis; meningitis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-245788

We report a case of a 67-year-old male recipient of a second renal allograft, presenting with a 9-month history of progressive cognitive and physical decline with features of Parkinsonism. He was HIV-negative. Serum and cerebrospinal fluid (CSF) cryptococcal antigen was positive though CSF culture was sterile. He had progressive deterioration despite induction and consolidation antifungal treatment. Postmortem brain examination confirmed a large burden of yeast forms in the substantia nigra with widespread chronic meningitis. The significant delay in presentation and diagnosis owing to the atypical, subacute neurocognitive features serves as a timely reminder of the variety of neurological presentations that may be associated with cryptococcal infection in solid organ transplant recipients.