Cryptococcosis occurring within 30 days after transplant is unusual. We present a case of
cryptococcosis diagnosed within 2 weeks of
liver transplant and cryptococcal
infection transmitted by
liver transplant is considered as the cause. A 63-year-old woman with hepatitis C virus-related
cirrhosis and
hepatocellular carcinoma had an orthotopic
liver transplant from a 45-year-old donor. The immediate postoperative course was smooth, although she was confused with a
fever,
tachycardia,
respiratory failure of 1 week's duration after the orthotopic
liver transplant. A liver biopsy was performed for
hyperbilirubinemia 2 weeks after the orthotopic
liver transplant that showed a Cryptococcus-like yeast. Her blood culture was reexamined, and it was confirmed as Cryptococcus neoformans that had been misinterpreted as candida initially. At the time of the re-examination, her sputum was clear. We checked her preoperative blood sample, retrospectively, for serum cryptococcal
antigen with negative result. She was on liposomal
amphotericin treatment for 1 month when her blood culture became negative. She was discharged home, with good liver function and a low
antigen titer for cryptococcal
infection. Cryptococcal disease usually develops at a mean of 5.6 months after transplant. However an early occurrence is rare. Apart from that, its variable clinical presentations make early detection difficult. It might be an early reactivation or a donor-derived
infection. The latter usually occurs in unusual sites (eg, the transplanted organ as the sole site of involvement). Our case presented as cryptococcoma and liver involvement was diagnosed by an unintentional liver biopsy.