Fatal cryptococcal meningitis in an AIDS patient complicated with immune reconstitution syndrome refractory to prolonged amphotericin B treatment

Abstract

Cryptococcus neoformans is a ubiquitous encapsulated environmental yeast that can cause severe central nervous system disease, primarily in immune compromised hosts. In patients with AIDS, the spectrum of cryptococcal central nervous system disease includes meningitis, cystic lesions, and mass-like cryptococcomas. We report a fatal case of meningitis and cerebritis caused by C. neoformans in an AIDS patient refractory to multiple courses of liposomal amphotericin B despite immune recovery with antiretroviral therapy. This case highlights ongoing diagnostic and therapeutic challenges in the face of treatment failure for cryptococcal meningitis and reinforces the need for improved treatment approaches.

Antifungal Combination of Ethyl Acetate Extract of Poincianella pluviosa (DC.) L. P. Queiros Stem Bark With Amphotericin B in Cryptococcus neoformans

“…Amphotericin B, a fungicidal agent, is considered the gold standard for the treatment of disseminated fungal infections ( WHO, 2018 ). Although antifungal resistance to this drug is rare among cryptococcal isolates, cases of therapeutic failure have been documented ( Singhal et al, 2016 ; Bandaranayake et al, 2018 ). Furthermore, prolonged treatment with AmB can lead to renal failure, hypokalemia, hypomagnesemia, and anemia ( Bermas and Geddes-McAlister, 2020 ).…”