The C neoformans isolate belonged to ST5 and molecular type VNI (var. On day 14 admission, pleural fluid cultured positive for Cryptococcus neoformans. However, during his hospitalization, a right pleural effusion developed and fever was not controlled. He was started on empirical treatment for pleural tuberculosis (TB). A computed tomography (CT) of the thorax showed a massive right pleural effusion without pulmonary parenchymal abnormalities. Pleural effusion presentation of cryptococcal infection as the only clinical presentation is rarely seen in pulmonary cryptococcosis, which may lead to be misdiagnosed, and the study on this subject will provide further insights.Ī 64-year-old man was hospitalized in our department and diagnosed as hepatic B cirrhosis. Mortality remains high, despite standard therapy with amphotericin B.Ĭryptococcosis is a significant life-threatening fungal infection in worldwide, mainly reported in immunocompromised patients. Peritoneal CrAg testing expedites diagnosis because growth on fungal media is slow. Cryptococcus species infection should be suspected in patients with clinical signs and symptoms of spontaneous bacterial peritonitis whose lymphocytic-predominant peritoneal fluid and cultures are negative for bacterial growth. People with recent UGIB seem to be at risk. neoformans is an opportunistic pathogen that causes peritonitis in non-HIV, cirrhotic patients. Amphotericin B was the primary treatment. When performed, peritoneal fluid cryptococcal antigen (CrAg) test results were positive. Peritoneal fluid analysis was abnormal and lymphocytic predominant. Eight (38%) patients experienced an upper gastrointestinal bleed (UGIB) within a month before peritonitis presentation. Alcohol abuse was the leading cause of underlying cirrhosis (n = 10, 48%). We performed a literature search of proven cryptococcal peritonitis cases in HIV-negative adults with underlying cirrhosis, included our own case, and collected demographic, infection risk factor, diagnostic, treatment, and outcomes data. Diagnostic challenges delay treatment, and mortality is high. A high index of suspicion is necessary as routine screening has very low yield for early detection.ĭisseminated Cryptococcus neoformans infection rarely causes peritonitis in non–HIV-infected patients but does affect cirrhotic patients. Screening all ALD patients with CrAg has not been beneficial.Ĭryptococcal infections in patients with ALD and liver transplantation result in poor outcomes due to diagnostic delays and concomitant impaired liver function with hepatotoxic therapies. Modalities for diagnosing cryptococcal infections include the rapid lateral flow cryptococcal antigen (CrAg) assay from serum and cerebrospinal fluid (CSF) specimens and multiplex polymerase chain reactions from CSF. Significantly, fever was uncommon, resulting in delays in diagnosis. Less than 10% of patients in a prospective study of non-HIV-infected cryptococcal meningitis patients had ALD. Evaluate the epidemiology, risk factors, pathophysiology, and clinical outcomes of cryptococcal infections in patients with advanced liver disease or liver transplantation.Ĭryptococcal infections in patients with advanced liver disease (ALD) are uncommon but associated with high mortality.
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