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隐球菌性脑膜炎是个重症,多见(35.1％)于接受类固醇疗法、淋巴网细胞瘤或其他恶性淋巴网状病患者。此病如不治疗,常迅速死亡。二性霉素B有一定的疗效,但由于有严重的肾毒性作用致其使用受到限制。据报告,另一种毒性较低的抗真菌药物5氟胞嘧啶的疗效也好。本文报告了2例淋巴网细胞瘤合并隐球菌性脑膜炎患者用二性霉素B和5氟胞嘧啶联合治疗的情况。1例淋巴网细胞瘤病人,男性,66岁,因出汗、寒战、搔痒入院治疗。其颈、背部有几处痂状损害,皮肤活检发现隐球菌。脑脊液培养有新生隐球菌。二性霉素B和5氟胞嘧啶的最小抑制浓度(MIC)分别为0.6微克/毫升和1.0微克/毫升。开始时给予二性霉素B静注,第一天剂量为20毫克,以后每天增加20毫克,直至每天剂量80毫克。一周内患者血液尿素浓度升至102毫克％(以前为32毫克％),肌酐清除率降
Cryptococcal meningitis is a severe and common (35.1%) in patients receiving steroid therapy, lymphoblastoma or other malignant lymphomas. If the disease is not treated, often die quickly. Amphotericin B has a certain effect, but its use is limited due to severe renal toxicity. Another less toxic antifungal, 5 flucytosine, has reportedly been effective. This article reports two cases of lymphocytoma with cryptococcal meningitis in patients with amphotericin B and 5 flucytosine combined treatment of the situation. One patient with lymphoblastoma, male, 66 years old, was hospitalized for sweating, chills and itch. The neck, back several scab damage, skin biopsy found cryptococcosis. Cerebrospinal fluid culture of Cryptococcus neoformans. The minimum inhibitory concentration (MIC) of amphotericin B and 5 flucytosine were 0.6 μg / ml and 1.0 μg / ml, respectively. The beginning of amphotericin B intravenous injection, the first day of a dose of 20 mg, 20 mg daily after the day, until the daily dose of 80 mg. Within one week the patient’s blood urea concentration rose to 102 mg% (formerly 32 mg%), creatinine clearance decreased