Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 12 / 12 / 2019

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A Mimic of Hepatic Encephalopathy: Two Cases of Cryptococcal Meningitis in North America

CASE REPORT

A Mimic of Hepatic Encephalopathy: Two Cases of Cryptococcal Meningitis in North America

Peng-Sheng Ting*,1, Anant Agarwalla2 and Tinsay A. Woreta2

1School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
2Division of Gastroenterology/Hepatology, The Johns Hopkins Hospital, Baltimore, MD, USA
*Correspondence to: Peng-Sheng Ting, School of Medicine, The Johns Hopkins Hospital, Baltimore 21287, MD, USA. Tel: +1-646-407-6759, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):191-193 DOI: 10.14218/JCTH.2019.00005
Received: January 24, 2019 Accepted: March 22, 2019 Published online: May 4, 2019

Abstract

In the non-human immunodeficiency virus infected population, cryptococcosis occurs primarily in people who are functionally immunosuppressed, including patients who have undergone solid organ transplantation requiring immunosuppressive medications, are on corticosteroids, or have renal failure or cirrhosis. Cryptococcal meningitis poses a particular challenge in the setting of cirrhosis because its clinical presentation can mimic hepatic encephalopathy. Here, we describe two patients with decompensated cirrhosis, both with a known history of hepatic encephalopathy who had lumbar punctures and were found to have cryptococcal meningitis. The first patient had a subacute fluctuating change in mental status, while the second patient had progressive subacute headaches, gait disturbance, and hearing loss. Both patients were treated with amphotericin B and flucytosine induction, but only the second survived to maintenance therapy. These cases demonstrate the importance of having a high index of suspicion for cryptococcal meningitis in cirrhosis and having a low threshold for performing a lumbar puncture when altered mental status or other neurologic complaints are not fully explained by hepatic encephalopathy. We also provide a brief review of the pathobiology of cryptococcal infection in cirrhosis and highlight the challenges in therapy.

Keywords

Cryptococcal meningitis, Decompensated cirrhosis, Liver transplant

 

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 191-193  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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