Campisi D, Tumminello A, Bivona A, Listi F
Istituto di Clinica Medica, Università, Palermo.
Recenti Prog Med. 2000 Jan;91(1):16-9.
It is presented the clinical case of a man 60 years old, heterosexual, suffering from chronic bronchopathy from old date, inveterate smoker, with previous diskotomy, herniotomy, who presents a symptomatology characterized from recurrent fever, productive cough, dyspnea, asthenia and headache for 6 month. He was admitted to hospital for fever and for a sensory slightly obnubilated. A series of investigations for typhus fever, cytomegalovirus, all with negative results were performed. He resulted negative also to the test to PPD as well as to markers of B and C hepatitis and the test for HIV. The study of the principal cancer markers also gave negative results, while the blood smears displayed leukopenia with monocytosis. The magnetic nuclear resonance of the brain showed the presence of multiple lesions of the brain and along the meninges: the examination of the liquor underlines the presence of the Cryptococcus neoformans, making to set the diagnostic of cryptococcal meningitis. The immunological study showed low values of CD4 in presence of normal values of CD8 and of a normal natural killer function. The exitus happened at 64th day. The interest of the case consists in the fact that in the medical Italian literature, unlike the international one, are not described cases of cryptococcal meningitis in patients not infected by HIV.
本文介绍了一名60岁男性的临床病例，该男性为异性恋，长期患有慢性支气管病，有长期吸烟史，曾接受过椎间盘切除术和疝修补术，出现反复发热、咳痰、呼吸困难、乏力和头痛症状6个月。他因发热和轻度意识模糊入院。进行了一系列关于斑疹伤寒、巨细胞病毒的检查，结果均为阴性。结核菌素试验、B型和C型肝炎标志物以及HIV检测结果也均为阴性。主要癌症标志物的研究结果也为阴性，而血液涂片显示白细胞减少伴单核细胞增多。脑部磁共振成像显示脑部和脑膜存在多处病变：脑脊液检查发现新型隐球菌，从而确诊为隐球菌性脑膜炎。免疫学研究显示CD4值较低，而CD8值正常，自然杀伤功能正常。患者于第64天死亡。该病例的意义在于，在意大利医学文献中，与国际文献不同，未描述未感染HIV患者的隐球菌性脑膜炎病例。
