Physiotherapy Approach to Improve Neuroplasticity in Cryptococcal Meningitis in Post Renal Transplant Recipient: A Case Report

Background: Cryptococcal Meningitis is an opportunistic infection caused by Cryptococcus neoformans. It has been reported to be an important cause of morbidity and mortality in solid organ transplant recipients. Common manifestations of the disease are of pulmonary and central nervous systems (CNS). Case description: We report a case of 21-year-old female, who is known case of cryptococcal meningitis post renal transplant. Clinically, she had symptoms of reduced muscle strength of bilateral lower limbs, paresis of left leg, impaired balance, generalised weakness, headache and blurred vision. On examination lower limb muscle strength, hand grip strength and balance were reduced. Functional independence score was 37 on FIM (Functional Independence Measure) scale, which suggests that patient is fairly dependent for daily activities. We programmed tailor-made rehabilitation to improve neuroplasticity and thus the functional independence. Purpose: To study the effect of physiotherapy rehabilitation in a rare case of cryptococcal meningitis. Methods: Physiotherapy was started in the ICU empirically to increase mobility and prevent secondary complications in the form of positioning, passive exercises and breathing exercises and continued in wards more aggressively with protocols to improve balance and muscular strength for 8 weeks. Result: 8 weeks of physiotherapy rehabilitation showed significant improvement in muscle strength, balance, and functional independence. We saw significant improvement in hand grip strength, lower limb manual muscle testing, balance and FIM score (90). Conclusion: Structured physiotherapy treatment along with medications can improve symptoms of cryptococcal meningitis in solid organ transplant patients. Keywords: Physiotherapy, Neuroplasticity, Cryptococcal meningitis, Solid organ transplant, Physiotherapy in Renal Transplant, Functional independence.