Cryptococcal meningitis in a patient with chronic hepatitis C treated with pegylated-interferon and ribavirin

Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-α and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis...

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Bibliographic Details
Published in:The Korean journal of internal medicine 2014, 29(3), , pp.370-374
Main Authors: Lee, Tae-Hee, Lee, Kee-Ook, Kim, Yong-Seok, Kim, Sun-Moon, Huh, Kyu-Chan, Choi, Young-Woo, Kang, Young-Woo
Format: Article
Language:English
Subjects:
Antifungal Agents - therapeutic use
Antiviral Agents - adverse effects
Case Report
Cryptococcus neoformans - immunology
Cryptococcus neoformans - pathogenicity
Drug Therapy, Combination
Female
Hepatitis C, Chronic - diagnosis
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - immunology
Humans
Immunocompromised Host
Interferon-alpha - adverse effects
Meningitis, Cryptococcal - drug therapy
Meningitis, Cryptococcal - immunology
Meningitis, Cryptococcal - microbiology
Middle Aged
Opportunistic Infections - diagnosis
Opportunistic Infections - drug therapy
Opportunistic Infections - immunology
Opportunistic Infections - microbiology
Polyethylene Glycols - adverse effects
Recombinant Proteins - adverse effects
Ribavirin - adverse effects
Time Factors
Treatment Outcome
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Summary:Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-α and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis C virus (HCV) infection. She had been treated for 7 months. Her headaches were refractory to analgesics, and she developed subtle nuchal rigidity. The cerebral spinal fluid (CSF) revealed a white blood cell count of 205/mm(3), 51 mg/dL protein, 35 mg/dL glucose, and negative Cryptococcus antigen. The CSF culture resulted in no growth. Five days later, the CSF was positive for Cryptococcus antigen. We administered amphotericin B and flucytosine, followed by fluconazole. Approximately 2 months later, she was discharged. For the first time, we report a case of cryptococcal meningitis during the treatment of chronic HCV with PEG-interferon-α and ribavirin.
ISSN:1226-3303
2005-6648
DOI:10.3904/kjim.2014.29.3.370