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  • Snapshot
    • 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)
  • Introduction
    • 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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