Cryptococcal pneumonia and meningitis in a renal transplant recipient with a false negative serum cryptococcal antigen due to postzone phenomenon

Cryptococcal infection can cause significant morbidity and mortality in immunocompromised patients. We present a patient who was diagnosed with cryptococcal meningitis and pulmonary disease in the setting of a history of renal transplantation. The diagnosis was made based on growth of Cryptococcus n...

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Bibliographic Details
Published in:IDCases 2023-01, Vol.34, p.e01898, Article e01898
Main Authors: Ware, Chelsea, Meledathu, Sherin, Tariq, Zoon, Yee, Rebecca, Lichtenberger, John P., Siegel, Marc O.
Format: Article
Language:English
Subjects:
Case Report
Cryptococcal meningitis
Cryptococcal pneumonia
Post-zone phenomenon
Serum cryptococcal antigen
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Summary:Cryptococcal infection can cause significant morbidity and mortality in immunocompromised patients. We present a patient who was diagnosed with cryptococcal meningitis and pulmonary disease in the setting of a history of renal transplantation. The diagnosis was made based on growth of Cryptococcus neoformans in blood cultures and identification of cryptococcal antigen (CrAg) in cerebral spinal fluid (CSF) using a lateral flow assay (LFA). Our case is unique since the initial serum CrAg was falsely negative due to excess cryptococcal antigen preventing the formation of antigen-antibody complexes, referred to as the postzone phenomenon. This phenomenon has been reported on CSF samples but rarely reported on serum samples in patients without an HIV diagnosis.
ISSN:2214-2509
2214-2509
DOI:10.1016/j.idcr.2023.e01898