[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
December 1985

Ketoconazole Therapy for AIDS Patients With Disseminated Histoplasmosis-Reply

Author Affiliations


Arch Intern Med. 1985;145(12):2272. doi:10.1001/archinte.1985.00360120144046

In Reply.  —Ketoconazole failed to prevent clinical relapse with disseminated histoplasmosis in the patient with AIDS described by Drs Gustafson and Henson. Their patient also failed amphotericin B therapy, presumably because of the severe immune incompetence associated with AIDS. Based on the encouraging experience of Dr Bonner and co-workers, I have used ketoconazole to prevent relapse in two patients with AIDS and histoplasmosis.1 Both patients subsequently suffered a relapse. The first patient, a 29-year-old male drug addict, developed recurrent disseminated histoplasmosis manifested as fever and chronic meningitis while receiving 400 mg/day of ketoconazole. Histoplasma capsulatum was isolated from the cerebrospinal fluid, but blood and bone marrow cultures were negative. His meningitis initially responded to amphotericin B therapy, but he eventually died with persistent central nervous system histoplasmosis. Neither ketoconazole nor amphotericin B cross the blood-brain barrier well, perhaps explaining the patient's relapse with chronic meningitis. The second patient, a