HYPONATREMIA AS THE INITIAL PRESENTATION OF CRYPTOCOCCAL MENINGITIS AFTER LIVER TRANSPLANTATION

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MANSOOR SAAD; JUHARDEEN HAMZAH; ALNAJJAR ASMA; ABAALKHAIL FAISAL; AL KATTAN WAEL; ALSEBAYEL MOHAMED; AL HAMOUDI WALEED; ELSIESY HUSSIEN

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Journal: Hepatitis Monthly Year:2015 | Volume:15 | Issue:9 Page(s): 0-0

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Title

HYPONATREMIA AS THE INITIAL PRESENTATION OF CRYPTOCOCCAL MENINGITIS AFTER LIVER TRANSPLANTATION

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Keywords

HYPONATREMIA

MENINGITIS

CRYPTOCOCCAL

LIVER TRANSPLANTATION

SYNDROME OF INAPPROPRIATE ADH (SIADH) SECRETION

Abstract

Introduction: Meningoencephalitis is the most common clinical manifestation of CRYPTOCOCCAL infection, as the organism has a propensity to invade the CNS. Patients often present with elevated intracranial pressure, focal motor deficits, altered mentation and internal hydrocephalus. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been reported as a notable cause of euvolemic HYPONATREMIA in immunocompromised patients.Case Presentation: A 67-year-old male with LIVER TRANSPLANTATION due to hepatitis C (HCV) related liver cirrhosis developed severe HYPONATREMIA four months after LIVER TRANSPLANTATION, which was discovered during routine clinic visit. Patient was referred to the emergency department, treated and discharged with normal serum sodium level. Few days later, he presented with dizziness, confusion, ataxia, abnormal muscle movements and leg pain. Laboratory investigations were consistent with SIADH and revealed a sodium level of 115 mmol/L. Brain MRI showed a leptomeningeal enhancement in the superior cerebellar sulci suspicious for infection. Lumbar puncture was performed and consistent with Cryptococcus neoformans infection; therefore, CRYPTOCOCCAL MENINGITIS was diagnosed. Amphotericin B was started for the patient for six weeks followed by fluconazole for one year. His level of consciousness improved significantly, and his serum sodium level slowly returned to its normal baseline over three weeks after starting amphotericin B.Conclusions: Symptomatic HYPONATREMIA secondary to SIADH remains a rare complication of CRYPTOCOCCAL MENINGITIS.

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APA: Copy

MANSOOR, SAAD, JUHARDEEN, HAMZAH, ALNAJJAR, ASMA, ABAALKHAIL, FAISAL, AL KATTAN, WAEL, ALSEBAYEL, MOHAMED, AL HAMOUDI, WALEED, & ELSIESY, HUSSIEN. (2015). HYPONATREMIA AS THE INITIAL PRESENTATION OF CRYPTOCOCCAL MENINGITIS AFTER LIVER TRANSPLANTATION. HEPATITIS MONTHLY, 15(9), 0-0. SID. https://sid.ir/paper/306938/en

Vancouver: Copy

MANSOOR SAAD, JUHARDEEN HAMZAH, ALNAJJAR ASMA, ABAALKHAIL FAISAL, AL KATTAN WAEL, ALSEBAYEL MOHAMED, AL HAMOUDI WALEED, ELSIESY HUSSIEN. HYPONATREMIA AS THE INITIAL PRESENTATION OF CRYPTOCOCCAL MENINGITIS AFTER LIVER TRANSPLANTATION. HEPATITIS MONTHLY[Internet]. 2015;15(9):0-0. Available from: https://sid.ir/paper/306938/en

IEEE: Copy

SAAD MANSOOR, HAMZAH JUHARDEEN, ASMA ALNAJJAR, FAISAL ABAALKHAIL, WAEL AL KATTAN, MOHAMED ALSEBAYEL, WALEED AL HAMOUDI, and HUSSIEN ELSIESY, “HYPONATREMIA AS THE INITIAL PRESENTATION OF CRYPTOCOCCAL MENINGITIS AFTER LIVER TRANSPLANTATION,” HEPATITIS MONTHLY, vol. 15, no. 9, pp. 0–0, 2015, [Online]. Available: https://sid.ir/paper/306938/en

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