title: Cryptococcal meningitis in patients with glioma: a report of two cases.
abstract: OBJECTIVE
  We describe two patients with high-grade glioma undergoing treatment with corticosteroids and chemotherapy who presented with cryptococcal meningitis and sepsis. This report of two cases highlights the importance of examining the efficacy of prophylactic antibiotic and/or antifungal regimens in this patient population due to their increased risk of opportunistic infections.
  
  
  METHODS
  A 73-year-old man with a history of glioblastoma multiforme (GBM), on dexamethasone and status post radiation therapy and two cycles of temozolamide, presented with decreased level of consciousness for 24 h and was found to have cerebrospinal fluid (CSF) and blood cultures positive for Cryptococcus neoformans. A 33-year-old man with a history of anaplastic astrocytoma, on dexamethasone and status post radiation therapy, four cycles of temozolomide and two cycles of Lomustine (CCNU), presented with headache, dizziness and photophobia and was found to have CSF and blood cultures positive for Cryptococcus neoformans.
  
  
  METHODS
  Both patients were treated with an initial regimen of amphotericin B and flucytosine for a minimum of two weeks and switched to fluconazole for 6 months to 1 year of treatment.
  
  
  CONCLUSIONS
  Patients with high-grade glioma treated with long-term corticosteroid therapy and chemotherapy are at increased risk of developing opportunistic infections. The two patients reported here developed cryptococcal meningitis and sepsis. Prophylactic regimens with either fluconazole or itraconazole currently exist that effectively decrease the incidence of both cryptococcal infections. Further investigations into the risk:benefit ratio of primary prophylactic therapy in this patient population may prove beneficial.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University School of Medicine, Durham, NC 27705, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Choi
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.forename: James J
authors.initials: JJ
authors.lastname: Vredenburgh
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: John H
authors.initials: JH
authors.lastname: Sampson
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000187:drug effects; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000009:adverse effects*; D017809:Fatal Outcome; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D005910:Glioma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008130:Lomustine / Q000009:adverse effects; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000139:chemically induced* / Q000473:pathology; D009894:Opportunistic Infections / Q000134:cerebrospinal fluid / Q000139:chemically induced* / Q000473:pathology; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D018906:Antineoplastic Agents, Alkylating; D008130:Lomustine; D003606:Dacarbazine; D003907:Dexamethasone; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine; D000077204:Temozolomide