Preventing Death Through Gift of Life: A Case of Cryptococcosis and Critical Role of Dermatology Consult in Organ Donation Related Infection

Abstract

Background: Primary cutaneous cryptococcosis is rare, and cutaneous lesions are most often due to disseminated disease. Cryptococcosis primarily affects immunosuppressed patients, such as organ transplant recipients.

Case: The dermatology inpatient service was consulted for an immunosuppressed, subsequently deceased patient who was being evaluated for potential organ donor status. The patient had a history of liver transplantation and had initially presented to an outside hospital with incidental hyponatremia of unknown etiology and a pulmonary nodule of unknown significance. Her outside hospital course was complicated by loss of consciousness necessitating intubation and eventual brain death. She was transferred to our hospital for organ donation evaluation. The transplant team consulted dermatology with concern for varicella. Clinical evaluation demonstrated numerous indurated flesh-colored papules without significant epidermal change. Biopsy ultimately showed cryptococcosis.

Conclusion: Cryptococcosis among solid organ transplant patients most often presents as extrapulmonary or disseminated disease, with a spectrum of cutaneous manifestations including cellulitis, papules, nodules, or ulcerative lesions. In this case, the patient most likely passed from disseminated disease (explaining her pulmonary nodule and hyponatremia). In this case, the inpatient dermatology team not only helped provide closure for the bereaved family, but also identified and halted a potentially dangerous transplant that would have otherwise put multiple organ recipients at risk for disseminated cryptococcal infection.