A46-42 The Silent Leak: What Hepatic Hydrothorax Wasn’t What It Seemed

Abstract Introduction Infection by Cryptococcus neoformans, occurs frequently in immunocompromised patients, particularly in HIV/AIDS and typically involves lungs or central nervous system. However, pleural involvement is uncommon. Because pleural effusions in cirrhosis are often attributed to hepatic hydrothorax, infectious etiologies may be overlooked. Case Presentation 51 year old man with hypertension, HIV infection, and alcoholic cirrhosis with esophageal varices who was admitted to the ICU for septic shock of unclear source. First images revealed a right large pleural effusion presumed secondary to hepatic hydrothorax. He underwent diagnostic thoracocentesis which showed transudative effusion (total cell count 219 uL, neutrophils 26%, lymphocytes 13%, monocytes 59%, LDH 31 U/L, total protein 2g/dL). After empiric antibiotics and anti fungal therapy, he stabilized and was able to be transferred to medical floors. Days later, patient developed recurrent right pleural effusion. Now, repeat thoracocentesis grew C. neoformans, subsequent fungal cultures and cerebrospinal fluid (CSF) analysis were also positive, confirming disseminated cryptococcosis. He was treated with amphotericin B deoxycholate and fluytosine for four weeks. Repeat lumbar puncture showed sterile CSF. Discussion/Conclusions This case represents an unusual presentation of disseminated cryptococcosis as infectious pleural disease. The initial transudative profile masked an evolving fungal infection, emphasizing the importance of repeat diagnostic evaluation when effusions recur in immunocompromised hosts. Early identification and therapy are essential to improve outcomes in cryptococcal pleural involvement. This abstract is funded by: none