Cortical laminar necrosis due to refractory status epilepticus in a kidney transplant patient with cryptococcal meningitis

A 56-year-old diabetic male underwent kidney transplant in 2010. He was brought to the hospital with complaints of vomiting and altered sensorium of 10 days duration. Lumbar puncture revealed cryptococcal meningitis. He was promptly initiated on liposomal amphotericin B and flucytosine. Immunosuppressive agents tacrolimus and mycophenolate mofetil were discontinued. There was an initial improvement in his sensorium but a few days later, he developed super-refractory status epilepticus. Despite early and aggressive management of seizures with multiple anti-epileptic drugs including intravenous anesthesia with thiopentone, his seizures persisted. This unfortunately led to cortical laminar necrosis, a condition in which there is severe brain injury. This condition is commonly a consequence of hypoxic ischemic encephalopathy, hypoglycaemic encephalopathy, status epilepticus, or ischemic stroke, and most patients either progress to brain death or remain in a persistent vegetative state.