A case of cryptococcuria involving the delayed development of cryptococcal meningitis after the initiation of hemodialysis

Abstract

Here, we report a case of occult cryptococcuria involving the delayed development of cryptococcal meningitis after the initiation of hemodialysis. The patient was a 72-year-old Japanese male. His medical history included diabetes and hypertension. At the age of 71, he developed tubulointerstitial nephritis, and steroid treatment was started. However, he needed to start hemodialysis therapy due to progressive kidney dysfunction 7 months later. On admission for the initiation of hemodialysis, his laboratory data showed elevated inflammatory marker levels, and Cryptococcus neoformans was isolated from his urine. However, we decided to follow him without providing any specific therapy because a re-examination of his inflammatory marker levels and a urinary culture produced negative findings. He was hospitalized for fever and personality changes 34 days after the initiation of hemodialysis therapy. Cryptococcus was isolated from his spinal fluid, and he was diagnosed with cryptococcal meningitis. He was treated with liposomal amphotericin B and flucytosine, which cured his meningitis. The combination therapy was switched to fluconazole, and he was discharged. Hemodialysis patients are immunocompromised, and hence, are at high risk of infectious diseases, including cryptococcosis. Cryptococcuria can co-exist with systemic cryptococcosis, and therefore, should be followed closely.