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January 1981

Cryptococcal Pyelonephritis and Disseminated Cryptococcosis in a Renal Transplant Recipient

Author Affiliations

From the Renal and Infectious Diseases Divisions, the Departments of Medicine (Drs Hellman, Hinrichs, Golden, and Hoffsten), Surgery (Dr Sicard), and Pathology (Dr Hoover), Washington University School of Medicine, St Louis. Dr Hellman is now at the Duluth Clinic Ltd, Duluth, Minn, and Dr Hoffsten is now at the Medical Associates Clinic, Pierre, SD.

Arch Intern Med. 1981;141(1):128-130. doi:10.1001/archinte.1981.00340010120023

Symptomatic cryptococcal pyelonephritis, meningitis, and disseminated cryptococcosis are described in a renal cadaver transplant recipient who subsequently died of Klebsiella pneumoniae sepsis. The presence of cryptococcuria and a subsequent positive CSF India ink stain led to the initial diagnosis of disseminated cryptococcosis. Therapy with 0.511 g of amphotericin B and 112.5 g of flucytosine for four weeks did not eradicate Cryptococcus from the kidney and was associated with hepatotoxicity. The importance of urinary examination and culture for C neoformans is emphasized. Cryptococcal pyelonephritis should be considered in the differential diagnosis of allograft rejection in the renal transplant patient.

(Arch Intern Med 141:128-130, 1981)