Shindo K, Mizuno T, Matsumoto Y, Hashimoto Y, Matsumura M, Ito A, Shionoiri H
First Department of Internal Medicine, Yokohama City University School of Medicine, Japan.
DICP. 1989 Sep;23(9):672-4. doi: 10.1177/106002808902300910.
A patient was admitted complaining of fever and headache. He was suspected of meningitis due to nuchal rigidity, and a lumbar puncture was performed. The patient was diagnosed as having cryptococcal meningitis, as Cryptococcus neoformans was found in an India ink preparation of the cerebrospinal fluid. Both amphotericin B and low-dose flucytosine (50 mg/kg/d) were concomitantly administered to the patient and his clinical symptoms improved. However, the combination therapy induced granulocytopenia and thrombocytopenia, which resolved after discontinuance of the drugs. Amphotericin B alone failed to cause granulocytopenia or thrombocytopenia. These results suggest that the mechanisms of granulocytopenia and thrombocytopenia may be toxic reactions to flucytosine in the azotemic state caused by amphotericin B. Our report emphasizes the need for clinicians to monitor for granulocytopenia and thrombocytopenia in patients receiving treatment with both amphotericin B and flucytosine, even when flucytosine is administered in a low dose.
一名患者因发热和头痛入院。由于颈部强直，怀疑他患有脑膜炎，于是进行了腰椎穿刺。在脑脊液的墨汁染色涂片中发现新型隐球菌，该患者被诊断为患有隐球菌性脑膜炎。两性霉素B和低剂量氟胞嘧啶（50mg/kg/天）同时给予该患者，其临床症状有所改善。然而，联合治疗引起了粒细胞减少和血小板减少，停药后这些症状得到缓解。单独使用两性霉素B并未导致粒细胞减少或血小板减少。这些结果表明，粒细胞减少和血小板减少的机制可能是在两性霉素B引起的氮质血症状态下对氟胞嘧啶的毒性反应。我们的报告强调临床医生需要监测接受两性霉素B和氟胞嘧啶联合治疗的患者是否出现粒细胞减少和血小板减少，即使氟胞嘧啶是低剂量给药。
