The treatment of amphotericin B-resistant C neoformans meningitis: A case report and literature review

Rationale: Cryptococcal meningitis is caused by Cryptococcus neoformans and Cryptococcus gattii , predominantly affects immunocompromised host. Resistance to amphotericin B poses therapeutic challenges, especially in immunocompetent individuals, where evidence is scarce. Patient concerns: This study reports a case of an old immunocompetent male diagnosed with amphotericin B-resistant C neoformans meningitis. Diagnoses: Amphotericin B-resistant C neoformans meningitis. Interventions: Treatment failure occurred with both induction regimens (amphotericin B deoxycholate/fluconazole for 14 days followed by fluconazole/flucytosine for 29 days), then used salvage therapy combining amphotericin B colloidal dispersion (ABCD) in this amphotericin B-resistant C neoformans meningitis. Outcomes: Successful salvage therapy with ABCD/flucytosine was achieved in a case of amphotericin B-resistant C neoformans meningitis. However, the patient ultimately succumbed to multidrug-resistant Klebsiella pneumoniae meningitis secondary to prolonged dexamethasone use for ABCD infusion reaction prophylaxis, which induced significant immunosuppression. Lessons: ABCD is a feasible alternative treatment for amphotericin B-resistant C neoformans meningitis. During prolonged ABCD therapy, pharmacists must implement pharmaceutical care to ensure medication safety and mitigate adverse effects, thereby preventing treatment discontinuation or treatment failure.