Review Topic
  • A 56-year-old man with a history of HIV presents to the emergency room with fevers, headaches, and general malaise. A head CT shows soap bubble lesions and variable enhancing lesions, concerning for Cryptococcus. A lumbar puncture and subsequent India ink stain on cerebral spinal fluid show yeast with clear halos, confirming the diagnosis. He is admitted immediately and started on dual anti-fungal therapy. (Cryptococcal meningitis)
  • Drugs
    • flucytosine
  • Mechanism of action
    • the drug is converted to 5-fluorouracil and inhibits nucleic acid synthesis
    • cleared renally
  • Clinical use
    • Cryptococcal infections
      • used with amphotericin B
    • systemic fungal infections
      • candidal infections resistant to azoles
  • Adverse effects
    • bone marrow suppression
    • gastrointestinal upset
    • hallucinations
    • renal failure
      • use with caution in those with renal failure

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