Amphotericin B-induced leukoencephalopathy in a patient with cryptococcal meningitis

A 43-year-old male was diagnosed as having cryptococcal meningitis based on his clinical condition, cerebrospinal fluid (CSF) profile and high titer CSF cryptococcal antigen. The patient received intravenous amphotericin B at a total dose of 91 mg over 5 days. The therapy was then abandoned due to acute hepatorenal failure. The patient's neurologic status remained stable for 2 months, after which he began experiencing somnolence, confusion and a personality change. Cranial computed tomography revealed multifocal white matter lesions, and a brain biopsy showed a demyelination change with concurrent IgM and C1q deposition. A clinical diagnosis of amphotericin B-induced leukoencephalopathy was made. The patient's clinical condition was partially reversed after low-dose steroid therapy.