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

Abstract

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.

Keywords: Cryptococcus; Hepatitis C; Meningitis; PEG-interferon-α; Ribavirin.

Figure 1

Overall clinical course. BT, body temperature; VAS, visual analogue scale; ACV, Acyclovir + Ceftriaxone + Vancomycin; HD, hospital day; CSF, cerebrospinal fluid; WBC, white blood cell; CBC, complete blood count.