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Fluconazole resistant candida esophagitis in a patient infected with HIV.
Nellore SR; Gopalakrishna KV; Fairview General Hospital, Cleveland, OH.
December 30, 1995
Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:138.

24 year old white male with no history of IVDA and homosexuality presented initially in December 1991 with Toxic Shock Syndrome. Investigations at that time led to the diagnosis of HIV infection. His CD4 count was 4 cells per cul. He was started on Zidovudine, TMP & SMZ and Fluconazole. He presented with progressive dysphagia in May 1993. EGD revealed friable esophageal mucosa covered with thick white exudate. Fluconazole dose was increased to 400 mg/day. In spite of increased dose of Fluconazole the patients' dysphagia worsened. He was started on I.V. Amphotericin B and received a total therapy of 500 mg. He showed an excellent response with this treatment. The fungal susceptibility studies demonstrated Fluconazole MIC to C. Albicans 10 mcg/ml at 24 hrs. 20 mcg/ml at 48 hrs. and MLC greater than 80 mcg/ml at 24 hrs. Patient was restarted on oral Fluconazole for prophylaxis, however his clinical symptom recurred. He has shown a moderate clinical response to Itraconazole. Our case study demonstrates failure of Fluconazole to treat Candida Esophagitis in a severely CD4 depleted patient with HIV infection. Antifungal susceptibility studies may not be helpful in these patients.

Candidiasis, Oral/COMPLICATIONS/*DRUG THERAPY Fluconazole/*THERAPEUTIC USE Human HIV Infections/*COMPLICATIONS Pharyngeal Diseases/COMPLICATIONS/*DRUG THERAPY Treatment Outcome ABSTRACT

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