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Spontaneous fungal peritonitis in patients with hepatitis B virus-related liver disease
V Cleophas1, V George, M Mathew
1Department of Gastroenterology & Hepatology, C.M.C. Hospital, Vellore, Tamil Nadu, India.
Abstract:
Spontaneous bacterial peritoneal infections is recognized as a very common complication of cirrhotic ascites, but isolation of fungus in pure culture from ascitic fluid is relatively rare, even more so in the human immunodeficiency virus (HIV)-negative or nonimmunocompromised hosts. We describe two patients of spontaneous fungal peritonitis where the isolate was Cryptococcus neoformans. Both cases suffered from hepatitis B virus (HBV) infection. The clinical and laboratory profiles of both patients were similar to those of conventional spontaneous bacterial peritonitis. We suggest that it would be prudent to heighten clinical suspicion for fungal peritonitis in such cases.
Insights
Spontaneous fungal peritonitis is rare, even in non-immunocompromised patients. This study highlights two cases of Cryptococcus neoformans peritonitis in hepatitis B virus-infected individuals, suggesting increased clinical suspicion is warranted.
Area of Science:
- Infectious Diseases
- Hepatology
- Mycology
Background:
- Spontaneous bacterial peritonitis is a common complication in cirrhotic ascites.
- Fungal peritonitis is a rare complication, particularly in human immunodeficiency virus (HIV)-negative or non-immunocompromised individuals.
Observation:
- Two cases of spontaneous fungal peritonitis are presented.
- The causative fungal isolate in both cases was Cryptococcus neoformans.
- Both patients had a history of hepatitis B virus (HBV) infection.
Findings:
- The clinical and laboratory presentations of these fungal peritonitis cases mimicked conventional spontaneous bacterial peritonitis.
- Isolation of fungus in pure culture from ascitic fluid is uncommon, especially in non-immunocompromised hosts.
Implications:
- Heightened clinical suspicion for fungal peritonitis is recommended in patients with cirrhotic ascites, especially those with HBV infection.
- This case series broadens the understanding of rare fungal infections in liver disease patients.
- Early diagnosis and appropriate antifungal treatment are crucial for managing spontaneous fungal peritonitis.