Cryptococcus neoformans, an encapsulated fungus, is an important opportunistic pathogen that can cause
meningitis in im-munocompromised patients. Since patients with cryptococcemia have high mortality, it is essential to make an early diagnosis and promptly initiate antifungal
therapy. However, it is often very difficult to differentiate between
cryptococcal meningitis and
hepatic encephalopathy in patients with
liver cirrhosis, and there is delay in making the diagnosis. Therefore, these patients have a particularly grave prognosis and consequently many patients die before culture results become available. In one study, starting antifungal
therapy within 48 hours of the blood culture was associated with improved survival, but patients with
liver cirrhosis were significantly less likely to receive antifungal
therapy within 48 hours compared to those without
liver cirrhosis. Recently, the authors experience a case of a 68-year-old woman with
liver cirrhosis who presented with
fever and a drowsy mental status. She had a previous history of having been admitted for
infection-associated hepatic encephlopathy.
Cryptococcal meningitis and cryptococcemia were diagnosed by spinal puncture and culture of cerebrospinal fluid. In spite of adequate treatment, the patient developed multi-system organ failure and eventually expired. Herein, we report a case of
cryptococcal meningitis mimicking
hepatic encephalopathy in a patient with
liver cirrhosis.