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[Cryptococcal meningitis successfully treated with liposomal amphotericin B and voriconazole in an elderly patient]

Kotaro Ogaki1, Kazuyuki Noda, Jiro Fukae

  • 1Department of Neurology, Juntendo University School of Medicine, Izunokuni-shi, Shizuoka, Japan.

Brain and Nerve = Shinkei Kenkyu No Shinpo
|December 9, 2010
PubMed

Insights

This study reports a successful treatment of cryptococcal meningitis in an elderly patient using liposomal amphotericin B (L-AMB) and voriconazole (VRCZ). The combination therapy proved safe and effective, even with co-existing renal insufficiency.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Pharmacology

Background:

  • Cryptococcal meningitis is a serious opportunistic infection, particularly in immunocompromised individuals.
  • Corticosteroid use for conditions like microscopic polyangiitis can increase the risk of fungal infections.
  • Standard treatment guidelines aim to balance efficacy with minimizing drug-related toxicities, especially nephrotoxicity.

Observation:

  • An 81-year-old woman on corticosteroids presented with fever and altered consciousness, indicative of meningitis.
  • Cerebrospinal fluid analysis confirmed Cryptococcus neoformans infection, consistent with cryptococcal meningitis.
  • Neurological examination revealed disturbed consciousness and nuchal rigidity.

Findings:

  • Treatment with liposomal amphotericin B (L-AMB) led to clinical and cerebrospinal fluid (CSF) parameter improvements.
  • Addition of voriconazole (VRCZ) was necessary due to persistent cryptococcal antigen in CSF, leading to a further decrease in antigen titers.
  • The combined L-AMB and VRCZ regimen was well-tolerated, with no severe adverse events requiring treatment modification.

Implications:

  • This case suggests that the combination of L-AMB and VRCZ is a safe and effective treatment option for cryptococcal meningitis in elderly patients, including those with renal insufficiency.
  • The findings highlight a potentially valuable therapeutic strategy in a region where this specific combination has been rarely reported.
  • Successful management underscores the importance of tailored antifungal therapy in immunocompromised elderly patients.

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