Fungal Peritonitis by Cryptococcus neoformans: a case-report

This paper describes a rare case of fungal spontaneous peritonitis caused by Cryptococcus neoformans in a 77-year-old woman with decompensated hepatic cirrhosis due to non-alcoholic fatty liver disease.The patient presented with disabling abdominal pain and hepatic encephalopathy, leading to hospitalization.Diagnostic paracentesis revealed serohematic fluid, and subsequent culture identified C. neoformans on the 6th day of admission.Treatment was initiated with fluconazole, later escalated to liposomal amphotericin B based on sensitivity testing.The patient's hospital course was complicated by sepsis, acute kidney injury, anemia, urinary tract infection, and atrial fibrillation.Despite these challenges, the patient survived the acute infection phase, ultimately transitioning to palliative care after 28 days.This case highlights the importance of considering fungal etiology in cirrhotic patients with peritonitis, especially when risk factors are present.It also underscores the need for early detection, prompt treatment, and a multidisciplinary approach to management.The paucity of clear guidelines for antifungal use in this patient population emphasizes the need for further research to optimize diagnostic and treatment protocols for fungal peritonitis in cirrhotic patients.