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Xxx[A case of cryptococcal meningoencephalitis in a patient with acute myelomonocytic leukemia treated by methotrexate].
A case of cryptococcal meningoencephalitis in a 70-year-old male patient with acute myelomonocytic leukemia treated with high-dose methotrexate (HD-MTX) is reported. The patient had been initially treated with other drugs for leukemia and 8 months later he was admitted to our hospital complaining of a headache. Shortly after, he developed meningitis followed by petit mal seizures. The patient also complained of hearing loss and extremities tremor. Cerebrospinal fluid (CSF) contained numerous polymorphonuclear leukocytes without myeloperoxidase (MPO) activity, and cryptococcal bodies in the CSF. MTX was discontinued and 1 g of Vincristine (VCR) every day was started. The patient gradually recovered from all neurological symptoms. Serum and CSF levels of MTX and 5-MFO-H4PteGlu were at a very low level. The findings of CSF MPO and homovanillic acid (HVA) were negative and brain CT images showed no abnormalities except for delayed enhancement in the left parietal lobe. High levels of serum colony stimulating factor (CSF) were found and then the diagnosis of cryptococcal meningoencephalitis was established. Oral treatment with Amphotericin B (AMPH-B) was started for 16 days. The patient received induction therapy for leukemia using HD-MTX and AMPH-B. One year later he was well with no relapse of leukemia. We have reported a rare case of cryptococcal meningoencephalitis in a patient with acute myelomonocytic leukemia treated with HD-MTX.." "You're a good man." "She's confused." "I'm not confused." "I've known love." "Trust me." "Now go." "Before I change my mind." "Don't worry." "I'm sorry I brought this all down on you, but it was my grandmother." "Excuse me?" "My real grandmother." "I know all about the rest, but not about mine." "Guess what." "My real grandmother, she's a nurse." "And she's in the hospital." "And she's sick." " 0b46394aab
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