Fuchs Hans, von Baum Heike, Meth Martina, Wellinghausen Nele, Lindner Wolfgang, Hummler Helmut
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, Children's Hospital, University of Ulm, Eythstr. 24, 89075 Ulm, Germany.
Eur J Pediatr. 2006 Jul;165(7):476-80. doi: 10.1007/s00431-006-0111-6. Epub 2006 Apr 7.
Invasive aspergillosis is a rare condition in term and preterm infants. We present here the fatal case of a 28-week gestational age preterm baby who developed pulmonary, hepatic and central nervous system aspergillosis during the first days of life. A hyperechogenic lesion adjacent to the lateral ventricle was diagnosed by ultrasound and initially considered to represent periventricular leukomalacia. Within several days the lesion increased in size and was then falsely considered to be an intraventricular haemorrhage. Aspergillus fumigatus was ultimately isolated in the tracheal aspirates, ascites and in material recovered by open brain biopsy. Despite treatment with conventional and liposomal amphotericin B the infant patient died.
Invasive aspergillosis has to be considered in the differential diagnosis of an unusual hyperechogenic brain lesion in very low-birth-weight infants with persistent symptoms and signs of systemic infection despite broad-spectrum antibacterial therapy. Consideration of this diagnosis should result in an aggressive diagnostic work-up to allow early initiation of an appropriate treatment.
侵袭性曲霉病在足月儿和早产儿中是一种罕见病症。我们在此呈现一例孕28周的早产儿的致命病例，该婴儿在出生后的头几天内发展为肺部、肝脏和中枢神经系统曲霉病。超声诊断出侧脑室旁有一个高回声病变，最初认为是脑室周围白质软化。数天内病变增大，随后被错误地认为是脑室内出血。最终在气管吸出物、腹水中以及通过开放性脑活检获取的组织中分离出烟曲霉。尽管使用了常规两性霉素B和脂质体两性霉素B进行治疗，该婴儿患者仍死亡。
对于极低出生体重儿，在进行广谱抗菌治疗后仍有持续的全身感染症状和体征，且出现异常高回声脑病变时，鉴别诊断必须考虑侵袭性曲霉病。考虑到这一诊断应积极进行诊断检查，以便尽早开始适当治疗。
