Successful treatment of disseminated cryptococcosis in a liver transplant recipient with fluconazole and flucytosine, an all oral regimen |
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Authors: | N Singh Timothy Gayowski Ignazio R Marino |
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Institution: | (1) Infectious Diseases Section, VA Medical Center, University Drive C, Pittsburgh, PA 15240, USA Fax: + 1 412 683 6928, US |
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Abstract: | Amphotericin B, with or without 5-flucytosine, is currently the therapy of choice for cryptococcal infections. However, amphotericin
B, is nephrotoxic and requires long-term venous access for parenteral administration. The combination of fluconazole and flucytosine
is synergistic in vitro against Cryptococcus. To date, however, the efficacy of fluconazole and flucytosine for cryptococcosis in liver transplant recipients has never
been reported. We report a 66-year-old liver transplant recipient with disseminated invasive cryptococcus (presenting as cryptococcal
subcutaneous abscess, osteomyelitis, and serum cryptococcal antigen titer of 1:32). The administration of amphotericin B for
3 weeks led to nephrotoxicity without any clinical response (persistent abscess without change in serum cryptococcal antigen
titer). Fluconazole, at a dosage equivalent to 800 mg/day administered orally, and flucytosine, also given orally, led to
a clinical response and a steady decline in serum cryptococcal antigen titer, which became negative at 6 weeks of therapy.
The patient remains well 18 months after therapy. No adverse effects have been attributed to fluconazole or flucytosine. This
combination obviates the nephrotoxicity and the need for parenteral access required for amphotericin B infusion, and it can
be administered orally. The combination of fluconazole and flucytosine warrants future controlled trials for the treatment
of cryptococcal infection in liver transplant recipients.
Received: 11 March 1997 Received after revision: 11 June 1997 Accepted: 19 August 1997 |
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Keywords: | Cryptococcus liver transplantation antifungal therapy Liver transplantation Cryptococcus antifungal therapy Fluconazole flucytosine Cryptococcus liver transplantation |
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