Reversal of uniocular blindness with corticosteroids in a solid organ transplant recipient with cryptococcal meningitis and immune reconstitution syndrome (IRIS): A case report

J Mycol Med. 2023 Aug;33(3):101406. doi: 10.1016/j.mycmed.2023.101406. Epub 2023 May 13.

Abstract

Cryptococcal meningitis is a life-threatening infection commonly seen in patients with advanced HIV infection and solid organ transplant recipients. We report a case of cryptococcal meningitis with immune reconstitution syndrome (IRIS) who presented to us with a headache and complete loss of vision in the left eye. He was managed with antifungals and a short course of steroids, and he regained vision completely. In the hospital, he developed complications including tacrolimus toxicity, fluconazole-induced QT prolongation, and flucytosine-induced thrombocytopenia. Our case demonstrates the importance of a multidisciplinary approach in the management of complex cases like cryptococcal meningitis in solid organ transplant recipients.

Keywords: Cryptococcal meningitis; Immune reconstitution inflammatory syndrome; Isavuconazole; Optic neuritis.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones
  • Antifungal Agents / adverse effects
  • Blindness
  • HIV Infections* / complications
  • Humans
  • Immune Reconstitution Inflammatory Syndrome* / complications
  • Immune Reconstitution Inflammatory Syndrome* / drug therapy
  • Male
  • Meningitis, Cryptococcal* / complications
  • Meningitis, Cryptococcal* / drug therapy
  • Organ Transplantation* / adverse effects

Substances

  • Antifungal Agents
  • Adrenal Cortex Hormones