Fluconazole-resistant cryptococcal meningitis.

A 40-year-old HIV-positive man was admitted to Cecilia Makiwane Hospital in December 2001 with a history of severe headache, photophobia and fever. Indian ink staining of cerebrospinal fluid (CSF) revealed yeast cells with 3 5 budding forms per high-power field. A diagnosis of cryptococcal meningitis was made and the patient was started on amphotericin B. He reacted to this almost immediately, and was observed to have a spiking temperature, tachycardia, and dizziness. He was changed to oral fluconazole 400 mg daily. He improved and was continued on 400 mg of fluconazole for 2 months, and then 200 mg daily.