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Hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis
J I Lin1, M A Kabir, H C Tseng
1Department of Laboratory Service and Gastroenterology, Veterans Affair Medical Center, Dayton, Ohio 45426, USA.
Insights
Disseminated cryptococcosis can initially present as severe liver dysfunction and jaundice, mimicking hepatitis. This rare presentation, even in immunocompromised individuals, can lead to fatal hepatic failure.
Area of Science:
- Infectious Diseases
- Hepatology
- Mycology
Background:
- Cryptococcosis is a fungal infection often seen in immunocompromised individuals.
- Hepatobiliary dysfunction is typically associated with other causes, not fungal infections.
- Disseminated cryptococcosis can affect multiple organ systems.
Observation:
- A case of a patient presenting with symptoms of hepatitis and cholestatic jaundice is described.
- Initial serological tests for common hepatitis viruses and human immunodeficiency virus were negative.
- The patient's condition progressively worsened, leading to hepatic failure and death.
Findings:
- Autopsy revealed systemic cryptococcosis as the cause of extensive liver necrosis.
- Literature review identified only nine prior cases of cryptococcosis initially manifesting as hepatitis, cholangitis, or cholecystitis.
- Notably, only two of the reported cases with initial hepatic presentation were in immunocompromised patients.
Implications:
- Hepatobiliary dysfunction can be an unusual initial sign of disseminated cryptococcosis.
- This underscores the importance of considering fungal infections in unexplained hepatitis, even in non-immunocompromised individuals.
- Early diagnosis and treatment of cryptococcosis are crucial to prevent severe outcomes like liver failure.
Abstract:
A case of hepatobiliary dysfunction as the initial manifestation of disseminated cryptococcosis is described. The patient was admitted with symptoms of hepatitis with cholestatic jaundice. Antibody tests for hepatitis B and C and human immunodeficiency virus were negative. The patient continued to deteriorate clinically. Eventually, the patient succumbed to hepatic failure. Autopsy disclosed systemic cryptococcosis that caused extensive necrosis of the liver. In review of the literature, only nine cases of cryptococcal infection presenting as hepatitis, cholangitis, and cholecystitis as initial manifestation were reported. Four of these patients had been subjected to exploratory laparotomy for clinical suspicion of acute abdomen. One patient developed cirrhosis as a result of cryptococcal hepatitis. Two patients succumbed to hepatic failure. Cryptococcosis is known to occur commonly in immunocompromised patients, yet only two reported cases presenting as hepatitis were associated with immunocompromised status.