, Volume 254, Issue 10, pp 1443-1444,
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Date: 02 Apr 2007

Return of meningeal symptoms in a patient treated for cryptococcal meningitis

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Sirs: A 28-year-old Guinese man was admitted to our hospital with a 3-week history of severe headache, vomiting and fever. Ten months earlier he was diagnosed with AIDS. The presenting AIDS-defining illness then, was disseminated cryptococcosis: Cryptococcus neoformans had been recovered from CSF, bronchoalveolar washings, and blood. Standard treatment of CM with amphotericin B and flucytosine followed by fluconazole [1] resulted in clinical and microbiological cure. The patient had been taking fluconazole 200 mg QD PO as secondary prophylaxis since. After successful treatment of CM, HAART was initiated. This preceded admission by 320 days. The CD4 cell count rose from 0 to 120 cells/µl and HIV1-RNA to undetectable levels (<50 copies/ ml). There was no reason to doubt compliance to fluconazole prophylaxis.

On examination an ill-looking man was seen, with low-grade pyrexia and stable haemodynamics. He was alert and cooperative, with no signs of meningism or mental confusion. Neurological ...