title: Liposomal amphotericin B for a case of intractable cryptococcal meningoencephalitis and immune reconstitution syndrome.
abstract: We examined the efficacy of liposomal amphotericin B (L-AMB) for intractable cryptococcal meningoencephalitis in a patient with acquired immunodeficiency syndrome (AIDS) and the presence of immune reconstitution syndrome (IRS) caused by the treatment. A 34-year-old patient presented with meningitis. Cryptococcal organisms were detected microscopically in the cerebrospinal fluid (CSF) with Indian ink staining, and were then cultured from the CSF. Initial treatment with amphotericin B and flucytosine (5-FC) or voriconazole and/or fluconazole failed to eradicate cryptococcal organisms from the CSF. Secondary treatment with L-AMB and 5-FC following seven months of antiretroviral therapy was successful. Simultaneously, treatment with L-AMB caused severe brain edema likely due to IRS. There were large differences in immune function improvement and liposomalization of the fungicide between the initial and secondary treatments. In conclusion, differences in immune status should be considered when administering L-AMB, in order to prevent IRS-related complications.
authors.affiliation: AIDS Medical Center; National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sasakawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Keishiro
authors.initials: K
authors.lastname: Yajima
authors.forename: Mio
authors.initials: M
authors.lastname: Sakai
authors.forename: Tomoko
authors.initials: T
authors.lastname: Uehira
authors.forename: Takuma
authors.initials: T
authors.lastname: Shirasaka
authors.forename: Toshio
authors.initials: T
authors.lastname: Makie
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D008081:Liposomes; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000935:Antifungal Agents; D008081:Liposomes; D000666:Amphotericin B