PMID- 34280874 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210819 IS - 2210-2612 (Print) IS - 2210-2612 (Electronic) IS - 2210-2612 (Linking) VI - 85 DP - 2021 Aug TI - A case of cryptococcal necrotizing fasciitis and immune reconstitution inflammatory syndrome in a renal transplantation recipient. PG - 106199 LID - S2210-2612(21)00701-X [pii] LID - 10.1016/j.ijscr.2021.106199 [doi] LID - 106199 AB - INTRODUCTION AND IMPORTANCE: Immunocompromised patients are at high risk of unexpectedly serious infections caused by uncommon bacteria or fungi. We experienced a case of Cryptococcus neoformans-induced necrotizing fasciitis (NF) of the lower extremities. The progress so far has been reported by the urology department [1]. Moreover, after the NF had been treated, the patient developed immune reconstitution inflammatory syndrome (IRIS). We report from surgeon's view point. CASE PRESENTATION: A 51-year-old male renal transplant patient complained of pain in both lower extremities (LE). After the initial debridement, periodic acid-Schiff after diastase digestion (D-PAS) staining confirmed the diagnosis. No symptoms were seen in the lungs or cerebrospinal system. The patient was reluctant to undergo surgical treatment but several debridement improved patient's condition. After the LE wound healed, prednisolone was discontinued, then painful nodules appeared on both LE. Based on the negative culture results and the fact that the patient had been treated with flucytosine and fluconazole, we suspected that the nodules had been caused by IRIS. CLINICAL DISCUSSION: It was difficult to diagnose Cryptococcus-induced NF and paradoxical IRIS. Cooperation from other specialists was essential. CONCLUSION: We think this patient needed earlier and more definitive debridement. Fortunately, we were able to save the patient's life and maintain his LE function. In immunocompromised patients, cryptococcus can be a pathogen. In addition, IRIS can occur during treatment. Management of IRIS is the capital point of sepsis management, careful anti-inflammatory drug control by specialists is required. CI - Copyright (c) 2021 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Kuwahara, Masamitsu AU - Kuwahara M AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: makuwa@naramed-u.ac.jp. FAU - Yurugi, Satoshi AU - Yurugi S AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Ando, Junji AU - Ando J AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Takeuchi, Mika AU - Takeuchi M AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Miyata, Riyo AU - Miyata R AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Harada, Masayuki AU - Harada M AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Masuda, Yasumitsu AU - Masuda Y AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Kanagawa, Saori AU - Kanagawa S AD - Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: plastic-surg@naramed-u.ac.jp. FAU - Yoneda, Tatsuo AU - Yoneda T AD - Division of Dialysis Unit, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: urology@naramed-u.ac.jp. FAU - Fukumori, Tatsuya AU - Fukumori T AD - Center for Infectious Diseases, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: cid@naramed-u.ac.jp. FAU - Ogawa, Taku AU - Ogawa T AD - Center for Infectious Diseases, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: cid@naramed-u.ac.jp. FAU - Nakamura-Uchiyama, Fukumi AU - Nakamura-Uchiyama F AD - Center for Infectious Diseases, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan; Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan. Electronic address: cid@naramed-u.ac.jp. FAU - Kasahara, Kei AU - Kasahara K AD - Center for Infectious Diseases, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan. Electronic address: cid@naramed-u.ac.jp. LA - eng PT - Journal Article DEP - 20210716 PL - Netherlands TA - Int J Surg Case Rep JT - International journal of surgery case reports JID - 101529872 PMC - PMC8318893 OTO - NOTNLM OT - Cryptococcus OT - Immune reconstitution inflammatory syndrome (IRIS) OT - Necrotizing fasciitis COIS- There are no conflicts of interest. EDAT- 2021/07/20 06:00 MHDA- 2021/07/20 06:01 PMCR- 2021/07/16 CRDT- 2021/07/19 20:28 PHST- 2021/06/17 00:00 [received] PHST- 2021/07/10 00:00 [revised] PHST- 2021/07/14 00:00 [accepted] PHST- 2021/07/20 06:00 [pubmed] PHST- 2021/07/20 06:01 [medline] PHST- 2021/07/19 20:28 [entrez] PHST- 2021/07/16 00:00 [pmc-release] AID - S2210-2612(21)00701-X [pii] AID - 106199 [pii] AID - 10.1016/j.ijscr.2021.106199 [doi] PST - ppublish SO - Int J Surg Case Rep. 2021 Aug;85:106199. doi: 10.1016/j.ijscr.2021.106199. Epub 2021 Jul 16.