Berinstein Jeffrey, Likhitsup Alisa, Vedula Sai Charan, Conjeevaram Hari
Internal Medicine, University of Michigan.
Division of Gastroenterology and Hepatology, University of Michigan.
Cureus. 2017 Dec 21;9(12):e1976. doi: 10.7759/cureus.1976.
Cryptococcal peritonitis is an under-recognized disease that is an important cause of mortality in end-stage liver disease. We report a 43-year old male with decompensated cirrhosis secondary to refractory autoimmune hepatitis on immunosuppression with hepatocellular carcinoma who developed cryptococcal peritonitis. The patient subsequently developed ischemic bowel and multisystem organ failure secondary to abdominal compartment syndrome, leading to rapid deterioration and death. Frequently, these patients experience delays in diagnosis and treatment, which leads to a rapid and high mortality. This case report synthesizes data regarding the optimal approach for screening and managing patients with cryptococcal peritonitis and proposes a pathogenic mechanism of mortality with implications for improved treatment in the future.
隐球菌性腹膜炎是一种未得到充分认识的疾病，是终末期肝病患者死亡的重要原因。我们报告一例43岁男性患者，该患者因难治性自身免疫性肝炎继发失代偿期肝硬化，正在接受免疫抑制治疗，并患有肝细胞癌，随后发生了隐球菌性腹膜炎。该患者随后继发腹部间隔综合征，出现缺血性肠病和多系统器官衰竭，导致病情迅速恶化并死亡。这些患者常常在诊断和治疗上出现延误，从而导致快速且高死亡率。本病例报告综合了关于隐球菌性腹膜炎患者筛查和管理的最佳方法的数据，并提出了一种死亡的发病机制，对未来改进治疗具有启示意义。
