Friedman J A, Wijdicks E F, Fulgham J R, Wright A J
Department of Neurologic Surgery, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 2000 Apr;75(4):403-8. doi: 10.4065/75.4.403.
Infection of the central nervous system by Blastomyces dermatitidis is a rare cause of meningoencephalitis. The existence of exclusive clinical infection of the meninges in the absence of pulmonary or other foci of infection has been debated. We describe a 20-year-old man presenting with meningoencephalitis caused by B dermatitidis. Blastomycotic infection was confirmed by isolation of the organism from brain tissue obtained at biopsy. Magnetic resonance imaging demonstrated progressive enhancement of basal meninges with involvement of bilateral basal ganglia and thalami. Treatment with amphotericin B arrested further neurologic decline. However, clinical and radiographic follow-up suggested damage to diencephalic structures. The diagnosis of blastomycotic meningoencephalitis is difficult to establish because no sensitive serologic test exists, and attempts to isolate the organism in cerebrospinal fluid obtained by lumbar puncture generally fail. A biopsy specimen of brain tissue is frequently necessary for the diagnosis. Survival is possible with timely initiation of therapy.
皮炎芽生菌感染中枢神经系统是引起脑膜脑炎的罕见原因。在没有肺部或其他感染灶的情况下，单纯脑膜临床感染的存在一直存在争议。我们描述了一名20岁男性，患有由皮炎芽生菌引起的脑膜脑炎。通过从活检获得的脑组织中分离出该病原体，确诊为芽生菌感染。磁共振成像显示基底脑膜逐渐强化，并累及双侧基底神经节和丘脑。两性霉素B治疗阻止了神经功能的进一步衰退。然而，临床和影像学随访提示间脑结构受损。芽生菌性脑膜脑炎的诊断很难确立，因为不存在敏感的血清学检测方法，而且通过腰椎穿刺获取的脑脊液中分离该病原体的尝试通常会失败。诊断往往需要脑组织活检标本。及时开始治疗有可能存活。
