Cryptococcal meningitis in pregnancy

Cryptococcal meningitis was diagnosed in a pregnant woman at 21 weeks' gestation. The availability of fetal tissues, blood, and amniotic fluid in such a patient receiving therapy with amphotericin B plus flucytosine afforded the opportunity to study the effects of the disease and therapeutic agents on the developing fetus. The amphotericin B concentration in amniotic fluid was 0.25 micrograms/ml and that of flucytosine was 168 micrograms/ml. The concentrations in cord blood were 0.3 micrograms/ml and 64.7 micrograms/ml, respectively. No evidence was found of amphotericin B or flucytosine toxicity in fetal tissues, although exposure of the fetus to these compounds was of brief duration.