Koba Shigeru, Ueda Kazuki, Mori Masahiro, Miki Kenji, Imashuku Shinsaku
Department of Internal Medicine, Uji-Tokushukai Medical Center, Uji, 611-0042, Japan.
Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, 611-0042, Japan.
Case Reports Hepatol. 2018 Dec 31;2018:5174518. doi: 10.1155/2018/5174518. eCollection 2018.
Diagnosis of invasive cryptococcal infection in apparently nonimmunocompromised patients is difficult and often delayed. Human immunodeficiency virus- (HIV-) negative patients with decompensated hepatic cirrhosis might be at high risk of cryptococcal infection. We report here an 82-year-old Japanese female with end-stage hepatic failure and undergoing renal dialysis, hospitalized with septic shock-like symptoms. The patient had had hepatitis B virus (HBV) infection in the past. She survived only 4 days following admission. During hospitalization, she was found to have pleural effusion and ascites. was obtained from blood culture but not from pleural effusion culture. Consequently, the patient was diagnosed as having invasive cryptococcosis in association with HBV-related hepatic cirrhosis. Unfortunately, the patient died prior to receiving antifungal agents. Twelve Japanese cases of hepatic cirrhosis-related invasive cryptococcal infection, consisting of previously described and this case, were summarized for discussion of the clinical features and outcomes.
在明显无免疫功能低下的患者中诊断侵袭性隐球菌感染很困难，而且往往会延迟。失代偿期肝硬化的人类免疫缺陷病毒（HIV）阴性患者可能有很高的隐球菌感染风险。我们在此报告一名82岁的日本女性，患有终末期肝衰竭且正在接受肾透析，因类似感染性休克的症状住院。该患者过去曾感染过乙型肝炎病毒（HBV）。入院后仅存活了4天。住院期间，发现她有胸腔积液和腹水。血液培养分离出了[具体病原体名称未给出]，但胸腔积液培养未分离出。因此，该患者被诊断为与HBV相关的肝硬化合并侵袭性隐球菌病。不幸的是，患者在接受抗真菌药物治疗前死亡。总结了包括先前描述的病例和本病例在内的12例与肝硬化相关的侵袭性隐球菌感染的日本病例，以讨论其临床特征和结局。
