Parkinsonism and prolonged cognitive decline as a manifestation of cryptococcal meningitis in a renal transplant patient

We report a case of a 67-year-old male recipient of a second renal allograft, presenting with a 9-month history of progressive cognitive and physical decline with features of Parkinsonism. He was HIV-negative. Serum and cerebrospinal fluid (CSF) cryptococcal antigen was positive though CSF culture was sterile. He had progressive deterioration despite induction and consolidation antifungal treatment. Postmortem brain examination confirmed a large burden of yeast forms in the substantia nigra with widespread chronic meningitis. The significant delay in presentation and diagnosis owing to the atypical, subacute neurocognitive features serves as a timely reminder of the variety of neurological presentations that may be associated with cryptococcal infection in solid organ transplant recipients.

Automated summary

This case study reports a 67-year-old male recipient of a second renal allograft who presented with progressive cognitive and physical decline, as well as features of Parkinsonism. The patient tested negative for HIV, but his serum and cerebrospinal fluid showed positive results for cryptococcal antigen. Postmortem brain examination revealed a large burden of yeast forms in the substantia nigra, indicating widespread chronic meningitis. This case serves as a reminder of the various neurological presentations that can be associated with cryptococcal infection in solid organ transplant recipients.