We present the case of an HIV-seropositive individual with cryptococcal meningitis who was found to have a fluconazole resistant strain of Cryptococcus neoformans. The individual required multiple rounds of amphotericin and fluconazole 800–1200 mg after several episodes of clinical relapse. Cerebrospinal fluid sterilization was achieved and maintained with high doses of fluconazole. This case demonstrates the emerging dilemma of increasing rates of fluconazole resistance in Cryptococcus and the clinical difficulties in meningitis management.
Bibliographical noteFunding Information:
We would like to thank Drs. Lillian Tugume, Reuben Kiggundu, Kenneth Ssebambulidde, and the ASTRO-CM team for their medical care. We also thank Andrew Akampurira, Tonny Luggya, Kizza Tadeo and the Makerere University Medical School Microbiology Laboratory team. We thank Drs. David Boulware and David Meya for their support in assisting with the drafting of the manuscript, and their input into the intellectual content. Support for this project was received via: the National Institutes of Neurologic Diseases and Stroke and Fogarty International Center (R01NS086312, K01TW010268, R25TW009345).
- Antifungal susceptibility
- Cryptococcal meningitis
- Cryptococcal meningitis relapse
- Fluconazole resistance