E0598 - A Rare Case of Disseminated Cryptococcosis Presenting as a Pleural Effusion in a Patient With Cirrhosis

William G. Jones, MD¹, Elizabeth Craig, DO², Charles Duckworth, MD^3
1HCA Memorial Health University Medical Center, Savannah, GA; ²University of South Alabama, Mobile, AL; ³Mercer School of Medicine, Savannah, GA

Introduction: Cryptococcus neoformans is an encapsulated yeast classically know as an opportunistic infection notorious for affecting patients with acquired immunodeficiency syndrome (AIDS) and other immunosuppressed patients. Over the last few decades, there have been very few cases of pleural effusions as the initial presentation of disseminated cryptococcosis, particularly with cirrhosis as the only risk factor for an immunocompromised state. Here we present and discuss this unique case.

Case Description/Methods: A 48 y/o male with a past medical history of alcoholic cirrhosis presented to the ED with shortness of breath. His past medical history is significant for multiple hospitalizations for decompensated hepatic cirrhosis, ascites, pleural effusions, portal hypertension, gastropathy, and s/p TIPS. MELD-Na score of 31. He presents with a 3-day history of worsening shortness of breath. Chest x-ray on admission showed a right sided pleural effusion concerning for hepatic hydrothorax and pleural fluid eventually grew yeast. Pleural fluid and blood cultures later grew cryptococcus neoformans. Respiratory culture His hospital course was complicated by worsening respiratory failure requiring a short period of intubation, acute kidney injury secondary to hepatorenal syndrome and amphotericin B toxicity, and eventually his demise.

Discussion: C. neoformans is an encapsulated yeast typically known for infecting immunocompromised hosts, classically patients with AIDS or patient’s receiving immunosuppression therapy [1]. The pathophysiology normally involves inhalation causing primary lung lesion then dissemination, usually to the meninges and brain. While AIDS and patients receiving immunosuppression therapy are predisposing factors for disseminated cryptococcosis, cirrhosis appears to be an increasingly more common risk factor. Interestingly, this patient presented initially with a large pleural effusion that later grew C. neoformans with eventual disseminated cryptococcosis with fungemia. In a 2015 case report by Wang et al, they reported only 5 documented cases of pleural effusion as the initial clinical presentation of disseminated cryptococcosis in the English language literature [2]. The 5 patients studied all had an obvious cause of immunosuppression, making our patient with cirrhosis an even more unique case.



Disclosures:


William G. Jones, MD¹, Elizabeth Craig, DO², Charles Duckworth, MD³. E0598 - A Rare Case of Disseminated Cryptococcosis Presenting as a Pleural Effusion in a Patient With Cirrhosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.