Ketoconazole in the treatment of cryptococcosis of the central nervous system

Abstract

Two patients with cryptococcosis of the CNS were treated with ketoconazole (KTZ), an imidazole derivative with fungistatic properties: they had either failed standard therapy (Amphotericin-B + 5-Fluorocytosine) or suffered intolerable side-effects to it. Both patients were administered KTZ 800 mg/day as monotherapy for six months without interruption and both responded. One month after KTZ therapy was withdrawn, however, a relapse of the infection was seen in one case. Side-effects were minimal during the trial of treatment. KTZ could be a useful drug in some cases of neurocryptococcosis.

Disseminated Cryptococcosis with Cutaneous Lesions

“…Abnormal mental status, as seen in this patient, has been found to be the most important predictive factor of a high risk of death during therapy in cryptococcosis (15). Ketoconazole, given earlier to the patient, has been reported successful in cryptococcosis (16), but did not seem to improve our patient very much. The rapid progression of the papules to warty, vegetating, crusted plaques and infiltrated plaques and nodules, as observed in our patient, is considered characteristic of widespread disseminated disease (17).…”