Sasakawa Atsushi, Yamamoto Yoshihiko, Yajima Keishiro, Sakai Mio, Uehira Tomoko, Shirasaka Takuma, Makie Toshio
AIDS Medical Center; National Hospital Organization, Osaka National Hospital, Osaka, Japan.
J Med Invest. 2008 Aug;55(3-4):292-6. doi: 10.2152/jmi.55.292.
We examined the efficacy of liposomal amphotericin B (L-AMB) for intractable cryptococcal meningoencephalitis in a patient with acquired immunodeficiency syndrome (AIDS) and the presence of immune reconstitution syndrome (IRS) caused by the treatment. A 34-year-old patient presented with meningitis. Cryptococcal organisms were detected microscopically in the cerebrospinal fluid (CSF) with Indian ink staining, and were then cultured from the CSF. Initial treatment with amphotericin B and flucytosine (5-FC) or voriconazole and/or fluconazole failed to eradicate cryptococcal organisms from the CSF. Secondary treatment with L-AMB and 5-FC following seven months of antiretroviral therapy was successful. Simultaneously, treatment with L-AMB caused severe brain edema likely due to IRS. There were large differences in immune function improvement and liposomalization of the fungicide between the initial and secondary treatments. In conclusion, differences in immune status should be considered when administering L-AMB, in order to prevent IRS-related complications.
我们研究了脂质体两性霉素B（L-AMB）对一名获得性免疫缺陷综合征（AIDS）患者难治性隐球菌性脑膜脑炎的疗效以及治疗引起的免疫重建综合征（IRS）的情况。一名34岁患者出现脑膜炎。脑脊液（CSF）经印度墨汁染色后在显微镜下检测到隐球菌菌体，随后从CSF中培养出该菌。最初使用两性霉素B和氟胞嘧啶（5-FC）或伏立康唑和/或氟康唑治疗未能从CSF中根除隐球菌菌体。在进行七个月的抗逆转录病毒治疗后，使用L-AMB和5-FC进行二次治疗取得成功。同时，使用L-AMB治疗导致严重脑水肿，可能是由于IRS。初次治疗和二次治疗在免疫功能改善和杀菌剂脂质体化方面存在很大差异。总之，在使用L-AMB时应考虑免疫状态的差异，以预防与IRS相关的并发症。
