Clinical Features and Outcomes of Cryptococcal Pleural Effusion in Liver Cirrhotic Patients

無論是否為免疫功能缺陷，隱球菌都可以造成人類的感染，尤其是在後天免疫不全的病人。隱球菌造成肋膜感染的比率並不高，即使在全身性的感染，這樣的表現依然是少數。肝硬化是一個會造成免疫功能低下的後天疾病，亦有一些報告關於這些病人得到隱球菌的病例，但關於隱球菌造成肋膜炎的病例少見，且其臨床表現及胸水的特徵亦多未描述。我們報告四個病例在過去五年中藉由胸水培養，確定有隱球菌造肋膜炎的肝硬化患者：包括三位女性和一位男性，其年齡範圍為53~75歲；形成肝硬化的原因，其中三例為肝炎病毒所造成，一例為原發性瞻汁性肝硬化症；臨床表現為發燒及呼吸困難，而其胸水的特徵全部皆為濾出液，其中白血球的分類有二例是淋巴球為主，另一例則以嗜中性球為主；其中只有一例其隱球菌感染侷限在胸水中，其他皆為全身性的感染；所有的病例皆有接受抗黴菌藥物的治療，但唯有侷限肋膜感染的一例，存活超過一個月但亦於三個月內死亡。回顧過去文獻中總共有三例的病例報告，唯一一個有胸水分析的病例亦為濾出液。肝硬化的病人發生肋膜隱球菌症並不常見，如何適當的予以早期診斷是個相當重要但不容易的課題。

關鍵字

隱球菌；胸水；肝硬化

並列摘要

Cryptococcus neoformans can cause infection in individuals with both normal and impaired immune function, especially in cases of human immunodeficiency virus infection. Pleural involvement is not common in cryptococcosis, even with disseminated infection. Liver cirrhosis is a disease known to lead to immunodeficiency. Herein, we report 4 cases of liver cirrhosis diagnosed as cryptococcosis with pleural involvement. The patients comprised 3 females and 1 male, and their ages ranged from 53~75 years. There were 3 hepatitis-related cases and 1 primary biliary-related case of cirrhosis. The characteristics of pleural effusion in our cases were all transudative, and the cellular response of the pleural effusion was neutrophil or lymphocyte-predominant. The prognosis of isolated pleural involvement is somewhat better than that of disseminated infection, although all our cases expired within 3 months. Three cases from the literature are also reviewed in this case series report. In summary, early diagnosis of cryptococcal pleural effusion in cirrhotic patients is still a challenge in clinical practice.

並列關鍵字

Cryptococcus neoformans ； pleural effusion ； liver cirrhosis

國際替代計量

Clinical Features and Outcomes of Cryptococcal Pleural Effusion in Liver Cirrhotic Patients

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