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[Neuromeningeal cryptococcosis and alcoholic cirrhosis]
P Artru1, N Schleinitz, B A Gauzere
1Service de Réanimation Polyvalente, Hôpital Félix-Guyon, Saint-Denis-de-la-Réunion.
Abstract:
Cryptococcal infections are usually described in immunosuppressed patients, but have also been described in patients with cirrhosis. We report a case of cryptococcal meningitis in a 62 year old man with Child class C alcoholic cirrhosis. Clinical signs associated mental confusion and discrete meningeal stiffness without fever. Diagnosis was confirmed by lumbar puncture which identified specific antigens and isolated Cryptococcus on Sabouraud medium. In patients with cirrhosis, cryptococcal meningitis infection should be considered in cases of isolated and unexplained mental confusion.
Insights
Cryptococcal meningitis can occur in patients with alcoholic cirrhosis, even without fever. Early diagnosis is crucial for patients with cirrhosis presenting with unexplained mental confusion.
Area of Science:
- Infectious Diseases
- Hepatology
- Neurology
Background:
- Cryptococcal infections typically affect immunocompromised individuals.
- However, cases have been documented in patients with liver cirrhosis.
- Alcoholic cirrhosis represents a significant risk factor for opportunistic infections.
Observation:
- A 62-year-old male with Child class C alcoholic cirrhosis presented with mental confusion and mild meningeal stiffness.
- The patient did not exhibit fever, a common sign of infection.
- Clinical presentation mimicked other neurological complications of advanced liver disease.
Findings:
- Lumbar puncture confirmed cryptococcal meningitis.
- Cerebrospinal fluid analysis revealed positive Cryptococcus antigens.
- Cryptococcus neoformans was isolated on Sabouraud medium.
Implications:
- Cryptococcal meningitis should be considered in cirrhotic patients with unexplained mental confusion.
- Prompt diagnosis and treatment are vital for improving outcomes in this vulnerable population.
- This case highlights the importance of broadening the differential diagnosis in patients with advanced liver disease.