Abstract
We present a case of relapsing cryptococcal meningitis unresponsive to standard therapy. Voriconazole induction, including the utilization of voriconazole therapeutic drug monitoring in both serum and CSF, with transition to voriconazole plus interferon-gamma (IFN-γ) was successfully used in a patient receiving antiretroviral therapy with abacavir/lamivudine and lopinavir/ritonavir. Initial voriconazole levels at standard doses of 4 mg/kg twice daily intravenously were low when co-administered with lopinavir/ritonavir but increased to recommended therapeutic levels with an increase of the voriconazole dose to 7 mg/kg twice daily. This case highlights the utility of voriconazole therapeutic drug monitoring when prescribed concurrently with a ritonavir boosted protease inhibitor and the potential role of combination therapy with IFN-G for refractory cryptococcal meningitis.
Acknowledgements
We thank Annette Fothergill, Gen Pennick and the Fungus Testing Laboratory, San Antonio, Texas for expertise in performing antifungal susceptibility testing and in the measurement of voriconazole concentrations.
Declaration of interest: G.R.T. has served as a consultant for Basilea. T.F.P. has received research support from Basilea, Merck, Pfizer, and Schering-Plough and has received honoraria or served as a consultant for Basilea, Merck, and Pfizer. All other authors have no potential conflicts to disclose.