Abstract An 81-year-old woman who had
microscopic polyangiitis that was being treated with
corticosteroids for 2 months was admitted to our department because of
fever and clouding of consciousness. Neurological examination showed disturbance of consciousness and nuchal stiffness. Analysis of cerebrospinal fluid (CSF) revealed
pleocytosis, low
glucose level, and elevated
protein levels. On the basis of the presence of Cryptococcus neoformans in CSF, the patient was diagnosed with
cryptococcal meningitis. On the basis of established practice guidelines,
liposomal amphotericin B (
L-AMB) was administered to avoid the possible nephrotoxicity of
amphotericin B. After the treatment was started, the patient's condition gradually improved. The results of CSF analysis also showed a gradual recovery. Because the cryptococcal
antigen in CSF did not disappear completely,
voriconazole (VRCZ) was administered orally; subsequently, the CSF cryptococcal
antigen titer gradually decreased. During the course of the treatment with
L-AMB and VRCZ, there were no severe side effects that required a change in treatment. To the best of our knowledge, in Japan, the combination of
L-AMB and VRCZ has rarely been reported to be effective for the treatment of
cryptococcal meningitis. The recovery of our patient indicates that the administration of
L-AMB and VRCZ to elderly patients with
cryptococcal meningitis and
renal insufficiency is safe and leads to a successful outcome.