CRYPTOCOCCAL MENINGITIS FOLLOWING A THROMBOTIC MICROANGIOPATHY IN AN UNRELATED DONOR BONE-MARROW TRANSPLANT RECIPIENT

In patients undergoing bone marrow transplantation cryptococcosis is r arely encountered. We report a fatal case of Cryptococcus meningitis i n a 12-year-old girl with acute lymphoblastic leukemia (ALL) in second remission who had a transplant from a human leukocyte antigen (HLA)-i dentical unrelated bone marrow donor. The conditioning regimen was thi otepa, cyclophosphamide and total body irradiation (TBI) graft-versus- host disease (GVHD) prophylaxis consisted of cyclosporin A, methotrexa te, and antilymphocyte globulin (ALG). The patient experienced stage I II GVHD responsive to high-dose corticosteroids. On day +54 a thrombot ic microangiopathy occurred. On day +64 neurological status worsened; a brain computed tomographic (CT) scan showed hyperdense lesions sugge sting fungal infection. Detection of cryptococcal antigen by latex agg lutination was positive but India ink slab and culture were negative. Despite treatment with amphotericin B, 5-flucytosine, and granulocyte- macrophage colony-stimulating factor, the patient died 13 days after t he diagnosis.