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The CsA withdrawal in cases with TMA at a stage when significant functional deterioration has not taken place can salvage the graft.

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Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared. Key words: Cryptococcosis, nephrotic syndrome, immunocompromised hostWith the increasing number of immunocompromised patients in the last decade, the systemic mycoses are increasing in importance as opportunistic infections. The etiologic microorganisms vary depending upon the type of immune dysfunction. Definitive diagnosis is often difficult to establish and usually requires invasive biopsy.Cryptococcosis or Torulosis first described by Busse in 1894, is an uncommon systemic mycosis caused by the encapsulated yeast Cryptococcus neoformans. Approximately 85% of patients with cryptococcosis have impaired cell mediated immunity. Acquired immuno-deficiency syndrome (AIDS) associated cryptococcal infections now account for 80-90% of all patients with cryptococcosis. 1Here we report a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who was never treated with immunosuppressive drugs. We believe this case to be the first report of disseminated cryptococcosis occurring in a nephrotic syndrome patient without AIDS or medical immunosuppression. Case ReportA 37-year-old farmer, who was diagnosed to have nephrotic syndrome, presented with one month history of low grade fever, lethargy, weight loss and increasing body swelling. Past medical history was significant for nephrotic syndrome, secondary to membranous glomerulonephritis two years back. He was treated with a diuretic and ACE inhibitor combination and never required steroids at any stage. He was however, lost to follow up for a year and was finally back with On examination, he appeared ill, temperature was 100 o F, blood pressure 160/90 mmHg, he was pale and had generalized oedema. General examination revealed multiple, variable sized, discrete, nontender subcutaneous nodules (Fig. 1)