Acute cerebellopathy as a probable toxic effect of flucytosine

• Published in: European journal of clinical pharmacology Vol. 51; no. 6; pp. 505 - 506
• Main Authors: CUBO DELGADO, E, SANZ BOZA, R, GARCIA URRA, D, BARQUERO JIMENEZ, S, VARGAS CASTRILLON, E
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 1997; Berlin
• Subjects: Aged; Aged, 80 and over; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Biological and medical sciences; Cerebellar Diseases - chemically induced; Cryptococcosis - drug therapy; Cryptococcosis - microbiology; Female; Flucytosine - adverse effects; Flucytosine - therapeutic use; Humans; Medical sciences; Pharmacology. Drug treatments; Human; Immunopathology; Nervous system diseases; Mycosis; Cryptococcus neoformans; Toxicity; Acute; Cryptococcosis; Immune deficiency; Cerebral disorder; Fungi; Infection; Case study; Antifungal agent; Chemotherapy; Treatment; Cerebellar disease; Central nervous system disease; Secondary effect; Flucytosine; Meningitis; Fungi Imperfecti; Thallophyta
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s002280050239

Cryptococcosis is the commonest fungal infection of the CNS and it is an important cause of morbidity and mortality in immunodeficient patients [1]. It has been occasionally described in immunocompetent patients [2]. We report a patient with no predisposing factors who was treated with flucytosine and amphotericin B for cryptococcal meningitis. Following treatment, she developed a reversible acute cerebellar syndrome that was probably secondary to the administration of flucytosine, an adverse effect that has not previously been described [3, 4]. An 87-year old women with no relevant personal or family history was admitted to the hospital for headache, fever, and confusion over the past week. The vital signs, general and neurological examination were normal. In laboratory tests, the urine, urea nitrogen, glucose, bilirubin, electrolytes, aspartate aminotransferase, creatine kinase, alkaline phosphatase, haematocrit, white-cell count, and platelet were also normal. A lumbar puncture was performed which showed: 60 typical lymphocytes per ml, adenosine deaminase (ADA) activity 6 U.l-1 (normal under 4 U.l-1), proteins 75.7 mg.dl-1, and glucose 13 mg.dl-1 with a glycaemia of 120 mg.dl-1. The microbiology study showed staining and a positive culture for Cryptococcus neoformans, and an antigen titre of 1/2080. The serology for HIV infection was negative, and other predisposing factors for this fungal infection, such as immunological defects, a lymphoreticular malignancy and sarcoidosis were excluded. A CT scan of the cranial-thoracic-abdominal regions was normal and tumour markers were absent.