Title:A Case of Cerebral Toxoplasmosis and Cryptococcosis Preferred Therapy
Associated Adverse Drug Reactions in a Patient Newly Co-diagnosed with
Acquired Immune Deficiency Syndrome
Volume: 18
Issue: 3
Author(s): Vaibhav Rajendra Suryawanshi, Bharat Purandare, Sujata Rege and Bijoy Kumar Panda*
Affiliation:
- Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune,
411038, Maharashtra, India
Keywords:
CNS co-infection, adverse reactions, sulfadiazine, amphotericin-B-deoxycholate, HIV/AIDS, CSF.
Abstract:
Purpose: The simultaneous occurrence of cerebral toxoplasmosis and cryptococcosis is
rare. The infections continue to be treated with sulfadiazine and amphotericin-B-based regimens
(preferred therapy), respectively. Both these drugs are linked to some serious adverse drug reactions
(ADRs). We report such a unique instance of both; the CNS co-infections and adverse drug
reactions to the preferred therapy.
Case Presentation: A 44-year-old Asian-Indian female was diagnosed with cerebral toxoplasmosis,
impending cryptococcal meningoencephalitis, and acquired immune deficiency syndrome
(AIDS). The preferred therapy of opportunistic CNS co-infections commenced. Within a week, she
had an occurrence of fall in hemoglobin concentrations (11.3 g/dL to 5.6 g/dL; grade IV), reticulocytosis
(1% to 3.2%), and indirect hyperbilirubinemia (0.5 mg/dL to 2.8 mg/dL; grade IV) after
sulfadiazine administration. The drug was discontinued and the patient was treated with hematocrit
transfusions. After amphotericin-B deoxycholate (AmBd) administration, the patient developed
hypokalemia (serum potassium; 4.5 mmol/L to 2.7 mmol/L) and increased serum creatinine (1.0 to
2.2 mg/dL; stage-I) levels. Hence, AmBd was discontinued and potassium correction was given.
The patient got diagnosed with sulfadiazine induced hemolytic anemia and AmBd induced acute
renal failure. He was switched to alternative therapy regimens for the treatment of cerebral toxoplasmosis
and cryptococcosis. Radiological investigations were followed up to confirm the clinical
outcomes of alternative therapy. Complete recovery from the ADRs and opportunistic infections
was observed.
Conclusion: The preferred therapy regimens for toxoplasmosis and cryptococcosis are accompanied
by potential adverse drug reactions, thus continuous monitoring is vital, especially in
the initial phases of therapy. Discontinuation of the treatment should be the preliminary intervention
in the management. Having said that, alternative therapy regimens had an optimal clinical response
in the present case.
