Treatment With Tamoxifen in Cryptococcal Meningitis

Inclusion Criteria: * Age ≥ 18 years * Cryptococcal meningitis (CM) defined as a syndrome consistent with CM and one or more of: * positive CSF India ink (budding encapsulated yeasts), * C. neoformans cultured from CSF or blood, * positive cryptococcal antigen Lateral Flow Antigen Test (LFA) in CSF * Informed consent to participate given by patient or acceptable representative * Known HIV infection status, or patient agrees to HIV testing on this admission Exclusion Criteria: * Pregnancy or breast-feeding * History of thromboembolic disease such as pulmonary embolism or deep venous thrombosis * On anti-coagulant medication * On medication known to prolong the QT interval other than fluconazole, such as fluoroquinolones or antidepressants. * Known cardiac conduction defect including long QT syndromes * QTc at baseline \> 500ms * Currently receiving treatment for cryptococcal meningitis and having received \> 4 days of anti-cryptococcal meningitis therapy * Known allergy to Tamoxifen * Currently or history of receiving treatment with Tamoxifen for breast cancer or other indication * Current or history of uterine cancer including endometrial cancer and uterine sarcoma * Renal failure (defined as creatinine \>3\*ULN (upper limit of normal), despite adequate hydration) * Failure to consent - the patient, or if they are incapacitated, their responsible relative, declines to enter the study * Allergy to amphotericin B or fluconazole