Korean J Intern Med.  2014 May;29(3):370-374. 10.3904/kjim.2014.29.3.370.

Cryptococcal meningitis in a patient with chronic hepatitis C treated with pegylated-interferon and ribavirin

• Lee TH
• Lee KO
• Kim YS
• Kim SM
• Huh KC
• Choi YW
• Kang YW

• KMID: 1792063
• DOI: http://doi.org/10.3904/kjim.2014.29.3.370

Abstract

Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-alpha and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis C virus (HCV) infection. She had been treated for 7 months. Her headaches were refractory to analgesics, and she developed subtle nuchal rigidity. The cerebral spinal fluid (CSF) revealed a white blood cell count of 205/mm3, 51 mg/dL protein, 35 mg/dL glucose, and negative Cryptococcus antigen. The CSF culture resulted in no growth. Five days later, the CSF was positive for Cryptococcus antigen. We administered amphotericin B and flucytosine, followed by fluconazole. Approximately 2 months later, she was discharged. For the first time, we report a case of cryptococcal meningitis during the treatment of chronic HCV with PEG-interferon-alpha and ribavirin.

Keyword

Cryptococcus; Meningitis; PEG-interferon-alpha; Ribavirin; Hepatitis C

MeSH Terms

Antifungal Agents/therapeutic use
Antiviral Agents/*adverse effects
Cryptococcus neoformans/immunology/*pathogenicity
Drug Therapy, Combination
Female
Hepatitis C, Chronic/diagnosis/*drug therapy/immunology
Humans
Immunocompromised Host
Interferon-alpha/*adverse effects
Meningitis, Cryptococcal/drug therapy/immunology/*microbiology
Middle Aged
Opportunistic Infections/diagnosis/drug therapy/immunology/*microbiology
Polyethylene Glycols/*adverse effects
Recombinant Proteins/adverse effects
Ribavirin/*adverse effects
Time Factors
Treatment Outcome
Antifungal Agents
Antiviral Agents
Interferon-alpha
Polyethylene Glycols
Recombinant Proteins
Ribavirin