Soto-Hernández J L, Ramírez-Crescencio M A, Moreno Estrada V M, del Valle Robles R
Department of Infectious Diseases, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Neurosurgery. 2000 Oct;47(4):973-6; discussion 976-7. doi: 10.1097/00006123-200010000-00037.
We report an unusual case of basal ganglia granulomas caused by Candida albicans that surrounded the proximal segment of a nonfunctional cerebrospinal fluid shunt in a previously healthy patient.
A 22-year-old woman had undergone ventriculoatrial cerebrospinal fluid shunt placement for posttraumatic hydrocephalus 3 years previously. One year later, a shunt revision was followed by wound dehiscence with local infection at the neck level. She received oral administration of antibiotics for 3 months until the wound closed. Twelve weeks before admission, the patient experienced pulmonary emboli. She received anticoagulants, and the distal segment of the shunt was removed. Five weeks after shunt removal, she presented with headache and left-sided hemiplegia caused by right basal ganglia inflammatory masses.
A stereotactic brain biopsy was performed, and the shunt remnants were removed. Microscopically, the lesions were acutely and chronically inflamed. C. albicans grew in tissue and in shunt hardware cultures. The patient was treated with 1.1 g of intravenously administered amphotericin B and orally administered ketoconazole; she recovered completely.
C. albicans brain granulomas occur rarely in immunocompetent patients. Despite the large size of the lesions and severe brain edema, the absence of an underlying disease contributed to complete resolution after shunt removal and antifungal therapy.
我们报告一例罕见的由白色念珠菌引起的基底节肉芽肿病例，该肉芽肿环绕着一名既往健康患者非功能性脑脊液分流管的近端。
一名22岁女性3年前因创伤后脑积水接受了脑室-心房脑脊液分流管置入术。一年后，分流管修复术后出现伤口裂开并伴有颈部局部感染。她接受了3个月的口服抗生素治疗，直至伤口愈合。入院前12周，患者发生肺栓塞。她接受了抗凝治疗，并移除了分流管的远端。分流管移除5周后，她因右侧基底节炎性肿块出现头痛和左侧偏瘫。
进行了立体定向脑活检，并移除了分流管残余物。显微镜检查显示，病变有急性和慢性炎症。白色念珠菌在组织和分流管硬件培养物中生长。患者接受了1.1克静脉注射两性霉素B和口服酮康唑治疗，完全康复。
白色念珠菌脑肉芽肿在免疫功能正常的患者中很少见。尽管病变体积大且脑水肿严重，但由于没有潜在疾病，在分流管移除和抗真菌治疗后实现了完全缓解。
