RT Book, Section
A1 Lampiris, Harry W.
A1 Maddix, Daniel S.
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176469419
T1 Antifungal Agents
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accessmedicine.mhmedical.com/content.aspx?aid=1176469419
RD 2024/04/19
AB CASE  STUDYThe  patient  is  a  37-year-old  African-American  man  who  lives  in  San  Jose,  California*.  He  was  recently  incarcerated  near  Bakersfield,  California  and  returned  to  Oakland  about  3  months  ago.  He  is  currently  experiencing  1  month  of  severe  headache  and  double  vision.  He  has  a  temperature  of  38.6°C  (101.5°F),  and  the  physical  exam  reveals  nuchal  rigidity  and  right-sided  sixth  cranial  nerve  palsy.  MRI  of  his  brain  is  normal,  and  lumbar  puncture  reveals  330  WBC  with  20%  eosinophils,  protein  75,  and  glucose  20.  HIV  test  is  negative,  TB  skin  test  is  negative,  CSF  cryptococcal  antigen  is  negative,  and  CSF  gram  stain  is  negative.  Patient  receives  empiric  therapy  for  bacterial  meningitis  with  vancomycin  and  ceftriaxone,  and  is  unimproved  after  72  hours  of  treatment.  After  3  days  a  white  mold  is  identified  growing  from  his  CSF  culture.  What  medical  therapy  would  be  most  appropriate  now?