[Cryptococcal meningitis successfully treated with liposomal amphotericin B and voriconazole in an elderly patient].
Abstract An 81-year-old woman who had microscopic polyangiitis that was being treated with corticosteroids for 2 months was admitted to our department because of fever and clouding of consciousness. Neurological examination showed disturbance of consciousness and nuchal stiffness. Analysis of cerebrospinal fluid (CSF) revealed pleocytosis, low glucose level, and elevated protein levels. On the basis of the presence of Cryptococcus neoformans in CSF, the patient was diagnosed with cryptococcal meningitis. On the basis of established practice guidelines, liposomal amphotericin B (L-AMB) was administered to avoid the possible nephrotoxicity of amphotericin B. After the treatment was started, the patient's condition gradually improved. The results of CSF analysis also showed a gradual recovery. Because the cryptococcal antigen in CSF did not disappear completely, voriconazole (VRCZ) was administered orally; subsequently, the CSF cryptococcal antigen titer gradually decreased. During the course of the treatment with L-AMB and VRCZ, there were no severe side effects that required a change in treatment. To the best of our knowledge, in Japan, the combination of L-AMB and VRCZ has rarely been reported to be effective for the treatment of cryptococcal meningitis. The recovery of our patient indicates that the administration of L-AMB and VRCZ to elderly patients with cryptococcal meningitis and renal insufficiency is safe and leads to a successful outcome.
Department of Neurology, Juntendo University School of Medicine, Izunokuni-shi, Shizuoka, Japan.
Kotaro
K
Ogaki
Kazuyuki
K
Noda
Jiro
J
Fukae
Tsuyoshi
T
Furuya
Takashi
T
Hirayama
Kenji
K
Fujishima
Nobutaka
N
Hattori
Yasuyuki
Y
Okuma
D000284:Administration, Oral; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage*; D000946:Antigens, Fungal / Q000134:cerebrospinal fluid; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008081:Liposomes; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000008:administration & dosage*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
D000946:Antigens, Fungal; D008081:Liposomes; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole