Today, Dr. Padilla presented a case of an elderly immunocompromised female s/p renal transplant who presented with chronic diarrhea, unintentional weight loss, intermittent headache, and elevated lipase with a largely unremarkable work up who was eventually found to have cryptococcal meningitis.
A few take home points...
- Immunosuppressed patients do not always follow Occam's razor and individual symptoms should be fully assessed. Only after this evaluation can we overlay our diagnoses to see if we can find a single unifying diagnosis. In our case, it would have been helpful to separate the new intermittent headache from her diarrhea.
- There are MANY conditions associated with a high serum lipase. Remember to think about the entire clinical picture when considering pancreatitis. In our patient, her lipase was a red herring (or possible lab error).
- Cryptococcal meningitis can have a subacute to chronic presentation with headache and lethargy being the primary symptoms (along with possible personality changes or memory loss). The majority of post-transplantation cases occur >1 year after transplant.