Pulmonary and Meningeal Cryptococcosis: Successful Treatment of the Meningitis With Lateral Cerebral Intraventricular Injection of Amphotericin B

Since the introduction of amphotericin B therapy, 60%-80% survival rates have been reported in cryptococcal meningitis, 1-3 a disease which had previously been uniformly fatal. 4 Before the use of this antifungal medication, any therapeutic measure which was credited with producing a remission of a cryptococcal infection with central nervous system involvement was viewed with considerable skepticism. Invariably reference was made to the occasional patient with longterm spontaneous remission. 5 In these cases, however, abnormalities of the spinal fluid persisted even though the patient remained asymptomatic. The present case is unique in that a complete remission of the cryptococcal meningitis, with persistently normal spinal fluid findings for over two years, was accomplished only after amphotericin B was injected directly into the lateral cerebral ventricle. We believe this is the first case to be so treated. The meningitis had failed to respond to the conventional intravenous and intrathecal therapy with this