Cryptococcal Peritonitis Complicating Hepatic Failure: Case Report and Review of the Literature

BACKGROUND: Cryptococcus neoformans is an encapsulated yeast that is an important cause of infection in patients with human immunodeficiency virus (HIV), lymphoid malignancies, and in those receiving corticosteroid therapy. The spectrum of diseases caused by C neoformans ranges from pulmonary infection to disseminated disease frequently involving the central nervous system, and occasionally skin and bone. Other extrapulmonary and extraneural sites of infection are less common. Cryptococcal peritonitis is an unusual entity, which is most often encountered in patients with end-stage renal disease undergoing ambulatory dialysis. CASE REPORT: We present a case of cryptococcal peritonitis which developed in a patient with hepatitis C-related cirrhosis. As little is know about the relationship between cirrhosis and cryptococcosis, we further reviewed the literature of this unusual but life-threatening relationship. DISCUSSION: Severe liver disease has not been fully recognized as a predisposing factor in the development of cryptococcal infection, particularly cryptococcal peritonitis, but the scattered case reports in the medical literature and our case report augment the association between the advanced liver disease and cryptococcal peritonitis. Therefore, cryptococcal infection should be considered in the evaluation of these patients with possible peritonitis.