Fatal Aplastic Anemia Resulting From Flucytosine

THE use of flucytosine (5-FC) as an alternative to amphotericin B in the treatment of cryptococcal meningitis has recently been advocated.¹,²Although physicians have been counselled to watch for the toxic effects of flucytosine on the kidney, liver, and bone marrow, emphasis has been placed on the ease of administration, good diffusion, and relative lack of toxicity of flucytosine as contrasted with amphotericin B.¹,²We report a case of aplastic anemia that resulted from flucytosine therapy. Report of a Case A 59-year-old man with diabetes mellitus was transferred to the hematology service of the Veterans Administration Hospital, Bronx, NY, for evaluation of pancytopenia. The patient, a weekend pigeon feeder, had been well until August 1970, when he was admitted to this hospital because of headache, nausea, and vomiting. Cerebrospinal fluid culture disclosedCryptococcus neoformans. The patient was treated with a total dose of 1,455 mg of amphotericin B.