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Background: Cryptococcal infections have been mostly associated with immunocompromised individuals, 80-90% of whom have been HIV-positive patients. Increasingly, cryptococcal infections are being reported in cirrhotic patients who are HIV-negative. The underlying immunologic defects in cirrhotic patients seem to play an important role in predisposing them to cryptococcosis and affecting their morbidity and mortality.
Case presentation: We present a case of disseminated cryptococcosis in an HIV-negative patient with underlying cirrhosis, who had rapid worsening of his hyponatremia with renal failure and was unable to recover, despite aggressive measures.
Conclusion: Cryptococcus is a more common culprit of infections seen in cirrhotic patients than what it was previously known, and a high index of suspicion is required to diagnose these patients. Identification of poor prognostic factors, early diagnosis and intervention is crucial in the management of these patients.
Keywords: cirrhosis; disseminated cryptococcosis; Cryptococcus; fungal infections; decompensated liver cirrhosis; cryptococcemia; HIV-negative
Cryptococcal infections have been mostly associated with immunocompromised individuals, most of whom are HIV-positive patients. In recent times, cryptococcal infections are increasingly being reported in cirrhotic patients, with an estimated 6-21% of the systemic fungal infections being cryptococcosis (1).
Cryptococcosis can present in various ways depending on the site of infection. The common sites that are involved are lung, CNS, skin, prostate, and medullary cavity of bones. Rarely, disseminated cryptococcosis can occur when two or more organ systems are involved. Cryptococcal peritonitis is another rare manifestation of cryptococcosis seen even less frequently than disseminated cryptococcosis, although it is one of the most common manifestations seen in those with liver disease (1 -9).
Various defects in the immune system that are specific for liver disease have been known to predispose cirrhotic patients to cryptococcosis. These include phagocytic dysfunction, complement and immunoglobulin deficiencies, and impaired cell-mediated immunity. Outcomes vary depending on the underlying conditions. Cryptococcal infections in this population have been associated with substantial morbidity and mortality, with some sources citing a mortality rate of 81% (1). We present a case of disseminated cryptococcosis in an HIV-negative patient with decompensated liver cirrhosis, whose condition deteriorated rapidly despite aggressive measures.
Case presentation
A 54-year-old male with a past medical history (PMH) of chronic hepatitis C and alcohol abuse with cirrhosis, stage III chronic kidney disease, and chronic hyponatremia was admitted...