Korean J Gastroenterol.  2014 Nov;64(5):294-297. 10.4166/kjg.2014.64.5.294.

A Case of Cryptococcal Meningitis Mimicking Hepatic Encephalopathy in a Patient with Liver Cirrhosis Caused by Chronic Hepatitis C

• Choi HM
• Jung GM
• Lee WK
• Lee HS
• Kim BS
• Seong CS
• Yoon SH
• Cho YK

• KMID: 2164433
• DOI: http://doi.org/10.4166/kjg.2014.64.5.294

Abstract

Cryptococcus neoformans, an encapsulated fungus, is an important opportunistic pathogen that can cause meningitis in immunocompromised patients. Since patients with cryptococcemia have high mortality, it is essential to make an early diagnosis and promptly initiate antifungal therapy. However, it is often very difficult to differentiate between cryptococcal meningitis and hepatic encephalopathy in patients with liver cirrhosis, and there is delay in making the diagnosis. Therefore, these patients have a particularly grave prognosis and consequently many patients die before culture results become available. In one study, starting antifungal therapy within 48 hours of the blood culture was associated with improved survival, but patients with liver cirrhosis were significantly less likely to receive antifungal therapy within 48 hours compared to those without liver cirrhosis. Recently, the authors experience a case of a 68-year-old woman with liver cirrhosis who presented with fever and a drowsy mental status. She had a previous history of having been admitted for infection-associated hepatic encephlopathy. Cryptococcal meningitis and cryptococcemia were diagnosed by spinal puncture and culture of cerebrospinal fluid. In spite of adequate treatment, the patient developed multi-system organ failure and eventually expired. Herein, we report a case of cryptococcal meningitis mimicking hepatic encephalopathy in a patient with liver cirrhosis.

Keyword

Cryptococcal meningitis; Cryptococcus; Liver cirrhosis

MeSH Terms

Aged, 80 and over
Brain/radiography
Cryptococcus/isolation & purification
Female
Hepatic Encephalopathy/complications/*diagnosis
Hepatitis C, Chronic/complications/pathology
Humans
Liver Cirrhosis/etiology/pathology
Meningitis, Cryptococcal/complications/*diagnosis/microbiology
Tomography, X-Ray Computed

Figure

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  Fig. 1. Brain CT revealed multifocal ill (arrows) defined low density in both white matter.

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  Fig. 2. India ink stain for Cryptococcus neoformans in the cerebrospinal fluid (×400).

Reference

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