Spontaneous Fungal Peritonitis versus Fungiascites

Introduction and Objectives

Infections in patients with liver cirrhosis (LC) are the cause of most decompensations, leading to a high mortality rate in 54% of cases. Describe the characteristics of the patients with spontaneous fungal peritonitis or fungiascites.

Materials and Patients

Three cases are presented. Patient A is a 58 years male with liver cirrhosis resulting from Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), Child-Pugh (CHP) B, MELD 3.0 score of 29 points, intractable ascites in secondary prophylaxis due to spontaneous bacterial peritonitis (SBP), systemic arterial hypertension, and chronic kidney disease KDIGO IIIa, biochemically with lymphocytes of 0.55 10³mcL; The patient B is a 58-year-old female with liver cirrhosis due to MASLD, CHP B, and MELD 3.0 score of 16 points, intractable ascites, type 2 diabetes mellitus, and systemic arterial hypertension, biochemically with lymphocytes of 0.88 10³mcL; The patient C is a 66-year-old male with LC secondary to alcohol use disorder and MASLD, CHP C, and MELD 3.0 score of 38 points with grade III acute on chronic liver failure with a history of hepatocellular carcinoma not eligible for oncological treatment. The ascites sediment underwent processing in the Mycology unit laboratory of the Faculty of Medicine at the National Autonomous University of Mexico (UNAM), where phenotypic and molecular identification of fungal agents was conducted.

Results

Candida Parapsilosis was isolated in patient A, cytologically without SBP data and negative bacterial culture of ascites (BCA). Days later, he presented to the emergency room with acute-on-chronic grade II liver failure with SBP data associated with healthcare. Following the previous culture showing growth, treatment with caspofungin was administered for 14 days before discharge. However, 15 days later, he was readmitted due to severe clostridioides difficile enterocolitis and esophageal candidiasis, ultimately passing away during hospitalization. Patient B exhibited isolation of Candida Albicans and Rhodotorula minuta, cytologically without SBP data and negative BCA, reporting abdominal pain and ascites grade II. The patient received intravenous Caspofungin for 7 days and Fluconazole for 10 days and emergency dialysis was required, hemodialysis was performed. The patient was hospitalized for 10 days. Patient C was diagnosed with Rhodotorula minuta, had a positive procalcitonin, lymphocytes at 0.61 10³mcL, and no biochemical cytological data of ascites for SBP. Bacterial culture of ascites was negative. Imaging showed left pleural effusion on chest x-ray and ascites on abdominal x-ray. The family requested discharge for palliative care, and the patient passed away.

Conclusions

Patients with a MELD score higher than 15 points, ascites, lymphopenia, and positive fungal culture of ascitic sediment, absence of spontaneous bacterial peritonitis in ascitic cytology, and negative bacterial culture results may indicate a grim survival outlook. Further research is needed to delineate the features of PFE or Fungiascites.

Statement of ethics: Consent was from the patient or from there legal guardian.

Declaration of interest: None.

Funding: Mycological study conducted by the Mycology Unit, Department of Microbiology and Parasitology, School of Medicine, National Autonomous University of Mexico.