Challenges in Diagnosing and Treating Cryptococcal Meningitis in Renal Transplant Recipients: A Case Series

Abstract Aims: Cryptococcal meningitis (CM) remains a significant complication in renal transplant (RT) recipients due to their immuno compromised status. This case series describes three RT patients who developed CM, highlighting the clinical presentations, diagnostic challenges, and management strategies. Case Presentation: The first case involved a 51-year-old male with chronic kidney disease and hypertension (HTN) who presented with fever, headache and generalized weakness. He was diagnosed with CM based on cerebrospinal fluid (CSF) analysis and treated with liposomal amphotericin B (AMB) and Fluconazole, resulting in symptomatic improvement. The second case was a 32-year-old male with a history of chronic graft dysfunction and antibody-mediated rejection. He presented with altered sensorium and was found to have CM. Despite appropriate antifungal treatment and immunosuppressive adjustments, the patient experienced neurological deterioration and ultimately succumbed to complications. The third case involved a 52-year-old male with diabetes and HTN who presented with headache and giddiness. He was diagnosed with CM and treated with liposomal AMB and Fluconazole. Although he initially showed improvement, persistent graft dysfunction required further adjustments in his treatment regimen. Discussion: These cases underscore the importance of early diagnosis and tailored management of CM in RT recipients. Close monitoring of renal function and careful adjustment of immunosuppressive therapy are crucial to improving patient outcomes. Conclusion: This case series provides valuable insights for clinicians managing similar patients, emphasizing the need for vigilance and prompt intervention in this vulnerable population.