Cryptococcal Meningitis

Abstract

SYNERGISTIC mechanisms of action and favorable clinical experience make flucytosine-amphotericin B combination therapy an attractive alternative to use of amphotericin B alone for treatment of cryptococcal meningitis.^1-3Fatal bone marrow aplasia occurred in a man with multiple myeloma following unusually small doses of both drugs. <h3>Report of a Case</h3> A 32-year-old man was admitted to the hospital on Nov 24, 1976, with recurrent pneumonia. He had suffered at least five bouts of lobar pneumonia between 1951 and 1974. Evaluations for an underlying illness, which included serum protein electrophoresis, were inconclusive. In December 1975, during hospitalization for recurrence of pneumonia,<i>Cryptococcus neoformans</i>was isolated from bronchial washings. During hospitalization, the diagnosis of multiple myeloma was made on the basis of serum protein electrophoresis, quantitative immunoglobulin assay showing notable elevation of IgG, and bone marrow examination. The patient left the hospital contrary to medical advice. In May 1976, weakness, nausea, fever,