Criptococosis cerebral, voriconazol, niveles plasmáticos y síndrome de reconstitución inmune. Reporte de un caso

Resumen

We report a 45 years old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycolate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma voriconazole trough levels were insufficient with a standard dose (0.7 µg/mL); therefore, the dose was increased thereafter to reach appropriate levels (4.5 µg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.