A. Korfel et al., CRYPTOCOCCOSIS IN HODGKINS-DISEASE - DESCRIPTION OF 2 CASES AND REVIEW OF THE LITERATURE, Annals of hematology, 76(6), 1998, pp. 283-286
Systemic mycosis caused by Cryptococcus neoformans frequently becomes
life threatening in patients with cellular immunodeficiencies. In cont
rast to AIDS patients, there are only a few reports of concurrent syst
emic cryptococcosis in patients with Hodgkin's disease (HD). Only two
of 75 (2.7%) patients with HD who were consecutively admitted to our h
ospital in the past decade developed Cryptococcus neoformans mans infe
ction. Both had stage IVB (Ann Arbor) HD with bone marrow involvement
and absolute lymphopenia (<1/nl). We have reviewed the literature and
analyzed the data of 54 cases with concurrent cryptococcosis and HD. P
resence of HD for greater than or equal to 12 months, stage IV disease
, absolute lymphopenia (<1/nl), and extensive pretreatment were the mo
st common features among these patients and must be regarded as predis
posing for acquiring a cryptococcal infection. In our patients antimyc
otic therapy was successful using liposomal amphotericin B (lipAmB) si
multaneously with cytotoxic therapy for HD. Drug level measurements pe
rformed in one patient revealed a higher level of amphotericin B in CS
F when the liposomal formulation was administered as compared with the
level in CSF after administration of conventional amphotericin B. To
our knowledge, this is the first report on antimycotic treatment of cr
yptococcosis with lipAmB in patients with HD. Regarding the favorable
therapeutic index of lipAmB as compared with conventional amphotericin
B, the drug should be considered as a less toxic and perhaps more eff
ective alternative in the therapy of acute cryptococcosis, especially
when cytotoxic treatment is administered simultaneously.