ArticleJournal of clinical and translational hepatology2019
A Mimic of Hepatic Encephalopathy: Two Cases of Cryptococcal Meningitis in North America.
Article in Journal of clinical and translational hepatology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 7 citations in OpenAlex.
- Cryptococcal Meningitis: Comparison of Short- (≤ 1 Week) Versus Longer-duration (> 1 Week) Liposomal Amphotericin B Induction Therapy and Factors Associated With Clinical Outcomes in HIV and Non-HIV Patients.Open forum infectious diseases · 2026Trial
- Organ-specific immune responses are strain-dependent in a mouse model ofMicrobiology spectrum · 2026Article
- Invasive fungal infections in patients with liver disease: immunological and clinical considerations for the intensive care unit.Intensive care medicine · 2025Review
- Mechanisms of fungal dissemination.Cellular and molecular life sciences : CMLS · 2021Review
- Kupffer Cells Mediate Systemic Antifungal Immunity.Trends in immunology · 2019Article
- [Analysis of influencing factors on hepatic encephalopathy in patients with non-cirrhotic portal hypertension].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2019Article
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In the non-human immunodeficiency virus infected population, cryptococcosis occurs primarily in people who are functionally immunosuppressed, including patients who have undergone solid organ transplantation requiring immunosuppressive medications, are on corticosteroids, or have renal failure or cirrhosis. Cryptococcal meningitis poses a particular challenge in the setting of cirrhosis because its clinical presentation can mimic hepatic encephalopathy. Here, we describe two patients with decompensated cirrhosis, both with a known history of hepatic encephalopathy who had lumbar punctures and were found to have cryptococcal meningitis. The first patient had a subacute fluctuating change in mental status, while the second patient had progressive subacute headaches, gait disturbance, and hearing loss. Both patients were treated with amphotericin B and flucytosine induction, but only the second survived to maintenance therapy. These cases demonstrate the importance of having a high index of suspicion for cryptococcal meningitis in cirrhosis and having a low threshold for performing a lumbar puncture when altered mental status or other neurologic complaints are not fully explained by hepatic encephalopathy. We also provide a brief review of the pathobiology of cryptococcal infection in cirrhosis and highlight the challenges in therapy.
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