[Clinical experience with fluconazole monotherapy in cryptococcal meningitis: report of four cases].

Four patients with cryptococcal meningitis have been treated with fluconazole in the past two years at the Department of Neurology, National Cheng Kung University Medical Center. There were three women and one man. Two patients had a history of anemia and one had undergone a splenectomy due to hypersplenism. Two patients were healthy before the onset of meningitis. After receiving fluconazole 300 mg per day for 8 to 13 weeks, three patients were cured without clinical evidence of recurrence during follow-up lasting from 2 to 17 months. One patient died from pneumothorax as a complication of subclavian vein cannulation. During the treatment course, there was no side effect except for one patient who had transient elevation of the GOT and GPT values which reversed spontaneously without a change in dosage. In the three successfully treated cases, the cryptococcal antigen titers began to decrease after the first week of treatment. Our preliminary experience shows that fluconazole alone is an effective and safe drug for the treatment of cryptococcal meningitis.