Neonatal serum bilirubin levels related to cognitive development at ages 4 through 7 years

Because the patient was clinically stable and ambulatory, and had no evidence of meningitis, a trial of 5-fluorocytosine was begun, to avoid amphotericin toxicity, and there was rapid and definitive resolution of all evidence of cryptococcal disease.

Abstract

instances of cryptococcosis. 4 Salyer et al ~ have proposed that the pathogenesis of primary pulmonary cryptococcal infection may be similar to that of primary pulmonary tuberculosis; the subpleural nodule often found at autopsy represents the initial focus of infection, and spread to the hilar lymph nodes follows. Our patient had no clinical evidence of parenchymal lung infection but did have paratracheal adenopathy. Since direct inoculation of the skin may produce cutaneous cryptococcosis2 our patient's scalp lesion may represent the portal of entry, with subsequent preauricular adenopathy. There was, presumably, hematogenous spread, as evidenced by the inguinal adenopathy, subcutaneous nodules, and liver granulomata. Confronted with cryptococcal infection, the clinician's impulse is to search for a predisposing condition, such as a malignancy, prolonged steroid therapy, or diabetes. However, none will be found in about 50% of patients. 7-9 Traditionally the treatment for cryptococcosis has been amphotericin. Recently 5-fluorocytosine has been used experimentally, even for meningitis, in patients unable to tolerate amphotericin. 9- 10 Because our patient was clinically stable and ambulatory, and had no evidence of meningitis, a trial of 5-fluorocytosine was begun, to avoid amphotericin toxicity. There was rapid and definitive resolution of all evidence of cryptococcal disease. Because some patients will not respond to a relatively low dose (60 mg/kg) of 5-fluorocytosine, they may need either a higher