Obstructive hydrocephalus in a renal transplant recipient: An avertable diagnostic delay in unraveling cryptococcal meningitis!

Cryptococcal infection constitutes 2.8% of opportunistic infections in solid-organ transplant recipients. The most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis. Rapid neurological deterioration in RTR with chronic meningitis despite antimicrobial therapy should alert towards the possibility of either alternative/polymicrobial etiology or complications including hydrocephalus. In this context, we report a RTR with chronic meningitis initiated on empirical antitubercular therapy in the absence of conclusive microbiological diagnosis despite serial cerebrospinal fluid analysis and later admitted with complication in form of obstructive hydrocephalus requiring external ventricular drainage which proved to be therapeutic (decreasing raised intracranial hypertension) as well as diagnostic (yielding Cryptococcus), thereby confirming alternative etiology of chronic meningitis.