Subdural effusion in chronic cryptococcal meningitis in a cirrhotic patient
Lee, Y.T.; Leung, N.W.; Kay, R.; Ng, H.K.
International Journal of Clinical Practice 51(4): 254-255
1997
ISSN/ISBN: 1368-5031 PMID: 9287272 Document Number: 476938
A case is reported in a 50-year-old man from Hong Kong , with cirrhosis of the liver due to chronic hepatitis B infection, who presented with a 3-day history of fever, confusion and abdominal distension. Examination revealed encephalopathy and speech impairment. India ink staining of cerebrospinal fluid (CSF) was positive for Cryptococcus neoformans. Amphotericin B (0.5 increased to 0.7 mg/kg daily) was started although CSF cultures still showed C. neoformans growth after 7 weeks of therapy. Computed tomography of the brain showed bilateral subdural collection consisting of hypodense fluid with ill-defined hyperdense material inside. The patient developed pericardial and massive left-sided pleural effusion and he died 10 weeks after admission. CSF cryptococcal antigen titres were 1:128 at week 1, 1:128 at week 3 and 1:512 at week 10. Postmortem examination showed haemorrhagic leptomeninges with gelatinous exudate consistent with cryptococcal meningitis; CSF had a moderate growth of C. neoformans which was also identified in the pleura and pericardium.