PMID- 19142596
OWN - NLM
STAT- MEDLINE
DCOM- 20090828
LR  - 20201209
IS  - 1615-6722 (Electronic)
IS  - 0723-5003 (Linking)
VI  - 104
IP  - 1
DP  - 2009 Jan 15
TI  - [Cryptococcal meningoencephalitis related to HIV infection with resistance to 
      fluconazole, relapse, and IRIS].
PG  - 58-62
LID - 10.1007/s00063-009-1007-9 [doi]
AB  - HISTORY AND CLINICAL FINDINGS: A 24-year-old HIV-positive patient was admitted to 
      hospital on account of increasing headache. INVESTIGATIONS: On admission, a 
      patient with severe headache, nausea and vomiting but without neurologic 
      deficiencies was seen. The diagnosis of a cryptococcal meningoencephalitis could 
      be confirmed by direct detection of cryptococci in the liquor. TREATMENT AND 
      COURSE: The patient was treated with a combination of fluconazole, flucytosine 
      and amphotericin B, and an antiretroviral therapy (ART) was started on account of 
      the severe immunodeficiency. The patient improved during the following weeks, and 
      fluconazole was administered as maintainance therapy. About 2 months later, the 
      patient presented again with severe headache. On lumbar puncture, a great amount 
      of cryptococci could be detected, and the antimycotic combination therapy was 
      restarted. An antimycotic testing of the cryptococci revealed a partial 
      resistance to fluconazole. Therefore, fluconazole was replaced by voriconazole 
      which has been continued ever since. Cryptococci could not be detected on further 
      investigations of the liquor. The patient's condition worsened again 8 months 
      after initiation of the ART. MR scan showed a slight cerebral edema. There was no 
      hint of an opportunistic infection nor of a lymphoma. The complaints were 
      supposed to be due to an immune restoration inflammatory syndrome (IRIS), and 
      administration of high steroid dosages was started. The complaints resolved 
      within 48 h, and the patient's condition has been stable ever since (19 months). 
      CONCLUSION: Cryptococcal meningoencephalitis is an opportunistic infection in 
      AIDS. Therapeutically, various regimens containing two to three different 
      antimycotic drugs show good efficacy but resistance to antimycotics has to be 
      considered. As in other HIV associated infections, an IRIS has to be taken into 
      account.
FAU - Seilmaier, Michael
AU  - Seilmaier M
AD  - Medizinische Klinik, Klinik fur Hamatologie, Onkologie, Immunologie, 
      Palliativmedizin, Klinikum Schwabing, Stadtisches Klinikum Munchen GmbH, 
      Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universitat Munchen, Munchen, 
      Germany. Seilmaier@lycos.de
FAU - Hecht, Anna
AU  - Hecht A
FAU - Guggemos, Wolfgang
AU  - Guggemos W
FAU - Rudisser, Klaus
AU  - Rudisser K
LA  - ger
PT  - Case Reports
PT  - Journal Article
TT  - Kryptokokkenmeningoenzephalitis bei einem HIV-positiven Patienten mit Rezidiv bei 
      Resistenz gegenuber Fluconazol und IRIS.
DEP - 20090114
PL  - Germany
TA  - Med Klin (Munich)
JT  - Medizinische Klinik (Munich, Germany : 1983)
JID - 8303501
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antifungal Agents)
RN  - 0 (Pyrimidines)
RN  - 0 (Triazoles)
RN  - 8VZV102JFY (Fluconazole)
RN  - JFU09I87TR (Voriconazole)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*drug therapy/microbiology
MH  - Adult
MH  - Anti-HIV Agents/therapeutic use
MH  - Antifungal Agents/adverse effects/*therapeutic use
MH  - Cryptococcus neoformans/drug effects
MH  - *Drug Resistance, Fungal
MH  - Drug Therapy, Combination
MH  - Fluconazole/adverse effects/*therapeutic use
MH  - HIV Seropositivity/*drug therapy/microbiology
MH  - Humans
MH  - Male
MH  - Meningitis, Cryptococcal/*drug therapy/microbiology
MH  - Pyrimidines/adverse effects/*therapeutic use
MH  - Recurrence
MH  - Triazoles/adverse effects/*therapeutic use
MH  - Voriconazole
EDAT- 2009/01/15 09:00
MHDA- 2009/08/29 09:00
CRDT- 2009/01/15 09:00
PHST- 2008/09/25 00:00 [received]
PHST- 2008/12/02 00:00 [accepted]
PHST- 2009/01/15 09:00 [entrez]
PHST- 2009/01/15 09:00 [pubmed]
PHST- 2009/08/29 09:00 [medline]
AID - 10.1007/s00063-009-1007-9 [doi]
PST - ppublish
SO  - Med Klin (Munich). 2009 Jan 15;104(1):58-62. doi: 10.1007/s00063-009-1007-9. Epub 
      2009 Jan 14.