Cryptococcal infection of the central nervous system

Two patients with cryptococcal infection of the central nervous system are described. These cases illustrate the variability in mode of presentation of this disease. Upon diagnosis, both patients were initially treated with a combination of amphotericin B and 5-fluorocytosine. Despite an early clinical and serological response, limiting side effects occurred in both cases and 5-fluorocytosine treatment was terminated. In Case 2, 5-fluorocytosine therapy was reinstituted at lower dosages later in the course of the illness, with good results. Combination therapy is superior to amphotericin B alone. However, to circumvent significant toxicity problems close monitoring of renal function, peripheral blood counts and serum 5-fluorocytosine levels are essential. Treatment is usually administered for a minimum of six weeks and remission is assessed on clinical, mycological and serological grounds. Thereafter, adequate follow-up is mandatory.