抗真菌薬の十分な治療効果が得られない，あるいは薬剤による副作用が出現し継続が困難なクリプトコッカス髄膜炎—治療困難に陥らないためのマネジメントと難治例への脳室内抗真菌薬投与

Cryptococcal Meningitis with Inadequate Response to Antifungal Therapy or Drug-Induced Side Effects That Make It Difficult to Continue Treatment: Management to Avoid Treatment Difficulties and Intracerebroventricular Antifungal Administration for Refractory Cases

クリプトコッカス髄膜炎では，抗真菌薬投与の十分な治療効果が得られない，あるいは薬剤による副作用が出現し抗真菌薬投与を減量・中断せざるを得ない状況をしばしば経験する。良好な予後を得るために最新の治療ガイドラインに沿った適切な薬剤選択を行うとともに，難治例では抗真菌薬の全身投与を継続したうえで，アムホテリシンBの脳室内投与を行うことも考慮される。

Abstract

The treatment of cryptococcal encephalomyelitis is often complicated by an inadequate response to antifungal therapy and the reduction or withdrawal of antifungal agents due to adverse effects. To achieve a favorable prognosis, patients should be treated with appropriate drugs according to the latest guidelines. In addition to systemic antifungal drug administration in refractory cases, intracerebroventricular administration of amphotericin B may be considered.